Long read: Mallie, Another conversation with the vet today...

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mom23seniors

mom23seniors

Member Since 2019
First off, I would again like to thank everyone who replied to my original thread back on Saturday. Your responses were so supportive and helpful and really made me feel like I will be able to handle the treatment aspect of my girl, Mallie's diagnosis.

As per my original post, I had to wait until today to call the vet back to let her know if I "wanted to go ahead with treating the diabetes". I called at 8:07am and left a message saying that I was thinking I'd go ahead with starting treatment, but I was needing some more cost breakdown of what was involved.

Here is the breakdown of what the vet said would be the cost (and I am in Canada, so these are $$CAD amounts)

1-10mL bottle of glargine-$80 (I was relieved she wants to start Mallie on glargine, as before today, I did not know what brand she was going to prescribe) and *she did say that her "official" recommendation is that the bottle is only good for one month, but that I could use it for 3 months 'unofficially'
1-AlphaTrak 2 animal blood glucose monitor $117
1-box of 50 strips (refills)-$96
1-box of syringes-$67

She would start Mallie on 1unit.
From our conversation on Saturday she had said that Mallie would be on one dose a day. So I am presuming that that she meant the 1unit would be one shot a day.
I have read a few snippets about cats only being on a single dose of Lantus a day.

Here is one, http://www.felinediabetes.com/insulin_selection_Nelson.htm for those interested

She would want me to do a 24 hour curve sometime over the holidays (when I'm off work) and there would be a consultation fee for her to go over the curve. She did not say how much the fee was. Is this something that is typically charged for?

I told her I went to a few different pharmacies around the part of the city we are in and that they had the cartridges of glargine (Lantus) available for about $100.
She seemed surprised at my comment, maybe she was playing it off as if I was the first person to have every told her this, I'm not sure.
She said that she would not prescribe more then 3 months worth of insulin at a time and so I should check with the pharmacy about "dispensing" fees for having to refill the prescription.
One pharmacy I spoke to (when I was price shopping on the weekend) said they need a prescription for the insulin since it was for an animal. The other pharmacy agreed when I asked if it was over the counter.

My question to you guys about the cartridges of Lantus...when you buy them, you have to buy all of them (15mL) together?

I am an anxious person generally, and her comment about only prescribing 3 months worth of insulin at a time makes me feel like she's trying to force me into getting the insulin from her.

When she talked about the alphatrak monitor I was quiet. She gave me a speel about human monitors being inaccurate. I am not planning on purchasing an alphatrak monitor. I definitely cannot afford the strips.

I have ordered a Bravo Meter & strips to start out with from diabetesexpress and I will see how it works. I am of course willing to try another meter that the strips are about the $80 range for 100 if needed. The Bravo meter should be here tomorrow.

She did ask me if I had any info on the commercial food. I told her that I was waiting to hear back from Purina who had replied to my original email (yesterday) and asked for 3 specific varieties of food I was interested in. So at least for right now, she is not pressuring me about the Purina DM canned.

I am to call the office back after I double check with the pharmacies about their dispensing fees. She said that they place their orders on Thursdays so if I let them know Thursday morning at the latest if I was wanting to get the Lantus through them.

I am sorry....all this rambling to say that I am going to call her tomorrow and say that I cannot afford the pet bg meter and that I am going to be using a human one.

Does anyone have any other tips or suggestions of what I could say to her regarding the human bg monitor?

It's been 10 days since we first confirmed sugars in Mallie's urine and it'll be a week tomorrow that we got the lab results back on her fructosamine. It seems too long.

Thankfully, Mallie's mood seems to have improved in the last 10 days since I cut out all kibble and switched her (and her brothers) to FF and Friskies. So that is a positive.

Thank you again for listening.
 
That is really good you are going to be using Lantus. It’s a good insulin for cats

Lantus is given twice a day not once a day. The normal starting dose is around 1 unit twice a day but check with your vet. We would not recommend dosing just once a day as Millie would be getting insulin for the first 12 hours then for the next 12 hours she would be being untreated. Lantus lasts around 12 hours in cats as they have a fast metabolism. What is her weight?

Have you looked at the 2 dosing methods on the Lantus page? They are at the top of the page in a yellow sticky. Have a look and see which one suits you better.

Remember the vet works for you... and you are paying her. And Mallie is your cat.
Just tell her that you can’t afford the pet meter strips and have gone ahead and bought a human meter. End of story. She can’t force you to buy a pet meter and they are not necessary. If she keeps on about it just say ‘I’ll keep that in mind but for now I have the human meter’
Our two dosing methods are based on the human meter reading so it will be much easier for you moving forward. Just think of us all standing behind you giving you moral support as you speak to your vet.
 
Those syringes sound expensive...I know in Canada they are more than the US but that still seems high. Could someone in CA clarify if there is a cheaper option?
 
Panic said:
Those syringes sound expensive...I know in Canada they are more than the US but that still seems high. Could someone in CA clarify if there is a cheaper option?
Click to expand...

oh gosh yes they are! Walmart and other pharmacies are definitely less expensive then that!

I actually work in a dental office so I can get the syringes at cost!
 
Bron and Sheba (GA) said:
Lantus is given twice a day not once a day. The normal starting dose is around 1 unit twice a day but check with your vet. We would not recommend dosing just once a day as Millie would be getting insulin for the first 12 hours then for the next 12 hours she would be being untreated. Lantus lasts around 12 hours in cats as they have a fast metabolism. What is her weight?

Have you looked at the 2 dosing methods on the Lantus page? They are at the top of the page in a yellow sticky. Have a look and see which one suits you better.

Remember the vet works for you... and you are paying her. And Mallie is your cat.
Just tell her that you can’t afford the pet meter strips and have gone ahead and bought a human meter. End of story. She can’t force you to buy a pet meter and they are not necessary. If she keeps on about it just say ‘I’ll keep that in mind but for now I have the human meter’
Our two dosing methods are based on the human meter reading so it will be much easier for you moving forward. Just think of us all standing behind you giving you moral support as you speak to your vet.
Click to expand...

Yes, that is my thinking as well! All that I’ve read here and on the web is that Lantus is a 12 hour insulin. My initial thought is that a single does of lantus every 24 hours would be like a roller coast-down and up, down and up!

As of last Saturday, Mallie weighed 5.3kg.

Thank you for your words of encouragement. I do not like confrontation and my anxiety sometimes gets the better of me. If I have a script planned of what I can say, I tend to do better in potentially uncomfortable situations.
 
In Canada you do not need a prescription for human insulin and there is no dispensing fee. Doesn't matter if it's for a cat or a human. It's like asking for Tylenol #1 OTC from the pharmacist.

Buying the 5 cartridges, while seeming more expensive up front, is actually more cost effective over time. With a vial, you will likely end up discarding some insulin whereas with the 3ml cartridges you can usually use up the entire cartridge and the unopened cartridges are good till the expiry date on the packaging provided they are properly stored in the fridge. The expiry date should be at least a year or more out when you buy the cartridges. You do not have to discard insulin after one month as that is only the length of time it has been fully tested based on human usage and many human do not refrigerate their in use insulin. If you keep the cartridge in use in the refrigerator, it will be good for a minimum of 3 or 4 months. Last time I purchased Lantus from Walmart I think it was around $117 for the 5 cartridges (15ml/1500 units vs. the vial of 10ml/1000units). Admittedly that was a few years back.

I agree with @Panic. That is an insane price for syringes. You can buy syringes at Walmart for about $40.00 per 100. You may be able to find a better price at Costco or even Shoppers if you collect their points or have a senior to pick them up for you. I think even diabetesexpress has better prices and sometimes has specials even cheaper than Walmart.

Tell your vet, a normal BG for a cat using a human meter is 2.8 (50 US) to 6.7 (120 US).
 
Agreed, tell the vet you will buy the insulin from the pharmacist. It was my pharmacist who told me to get cartridges. She had many kitties patients on Lantus and knew more than my vet. Depending on dose, a five pack will last you maybe even longer than a year. Ask the pharmacist for the package with the latest expiry date.

You can buy syringes at diabetesexpress too, but cheaper in stores. In BC, Safeway Pharmacy was about $35 a box of 100, most other stores at or a little under $40. I think Sobey’s owns Safeway here, so ask them. Loblaws/Canadian Superstore was also decent price.

Lantus dosing is twice a day. Very rarely is once a day a good idea, and not on a newly diagnosed cat. Once a day is for humans, but it doesn’t last that long in a cat.
 
Welcome to you and Mallie!

Like Linda mentioned it is SO easy to get insulin over the counter in Canada... You definitely do not need to worry about if your vet gives you a script or not ;). If it were me I wouldn't even mention your cat, just go for it! If the pharmacist turns you down, go to the next one! but I would be surprised if they did.

It depends on the pharmacy, but the price for 5 pens is between $110 and $120. I got my Lantus Pens at Shoppers and they were around $117 like Linda said. For what it's worth I bought those pens in March and I still have almost two whole pens left, I will definitely get a year of medication out of them so it is really not that much money when you consider you give it to your kitty twice a day, every day! It is long term a much better value for your dollar.

I use the freestyle lite glucosometer, I got it for free at Shoppers with the purchase of 100 strips which was $79.99 , but I sometimes get the strips at super store for $75.99. You can gather PC and Optimum points at both which you can use for... MORE DIABETIC SUPPLIES!!! (lucky!!).

I get my 100u syringes at shoppers as well, I buy a box for $39.99 - a box has 100 syringes (10 packs of 10 syringes).

I have heard that Costco pharmacy has the best prices for diabetic supplies, unfortunately I don't live close to one so I can't comment, but if you do it is definitely worth checking out. I also heard Safeway has pretty cheap syringes so again... maybe worth checking out.

I think if you're honest with your vet you might get more support from her, tell her you're totally committed to Mallie's treatment, and that you want to do a really great job but you just can't afford the alpha track, then supply her with the numbers that Linda gave you in the post above for using a human glucosometer. If you really can't make any headway with her just smile and nod, tell her you will think about the Alpha track and just go on with your Bravo ;)

ALSO: Fancy feast is on sale at Pet value for all of December for $5/10 cans! $0.50/can = bargain!

Good luck with everything, so far it looks like you're doing great :D
 
mom23seniors said:
I do not like confrontation and my anxiety sometimes gets the better of me. If I have a script planned of what I can say, I tend to do better in potentially uncomfortable situations.
Click to expand...
If it helps, go in with the mindset that you're informing them of your decision, not asking. I hate challenging people I feel are smarter than me, and the vet is the one with the degree after all. Just remember you are your cat's advocate, not to mention the one paying the bills so go in with your mind already made up!
 
If you send your vet a copy of the spreadsheet on a regular schedule, that wiil make her happy. After seeing the spreadsheet, my vet was so impressed that she insists that all her diabetic patients have one. If money is really tight, Some pharmacys will sell one pen at a time. It's more expensive in the long run, but it will get you started. Don't let your vet intimidat you. After some time on this board, you will know more about diabetic cats than she does.
 
I just wanted to update everyone.

I called my vet back on my lunch break (my anxiety was high all morning, my heart racing) and spoke to the receptionist. I told her that I was interested in the AlphaTrak due to the cost of the strips.
I also said I was wanting to get the cartridges of Lantus from my grocery store pharmacy since the cartridges are more cost effective then the 10ml vial she was going to prescribe me and if the doctor was not comfortable treating Mallie this way then I would find a doctor who would.
I didn’t mention that i knew that I could get the insulin over the counter...I wanted to see if the vet would give me the RX for the cartridges.
The receptionist (she’s so nice; im going to miss her) was understanding and said she’d talk to the doctor and that they’d get back to me.
The receptionist did call me back and left a message (I was at work) and like I suspected, she said the doctor wouldn’t give me a ‘script for the cartridges and that if I wanted to find another vet that they would transfer Mallies file. She said the doctor was hopeful that Mallie could go into remission in 3 months and so the extra insulin wasn’t necessary at this time.

When I had a break at work I did call another vet office that I’ve seen recommended in the community facebook groups I’m in many times.
I asked the receptionist if the the doctors write prescriptions for the grocery store pharmacy (ironically this new vet office is in the same shopping strip as my grocery store) and she said that they do that all the time for their clients and there would be no trouble sending the rx for the lantus cartridges to the pharmacy.

I also asked if their doctors only use animal bg testers and she said they actually use a human bg monitor in the office.

So I booked in for an exam on Friday afternoon (Which would’ve been the earliest I would’ve seen my now old vet this week) and they are going to get Mallies file from my (now) old vet.

I feel so relieved. Trying to communicate with my old vet was really stressful. I’m hopeful that this new vet is a better fit.

in the meantime I’m going to try to test mallies bg to see if I can get a reading. She’s been on strictly FF pates since Dec 1st. And I’d love to have at least one number before I take her to this new vet.

Thank you again for all your support. I may take a break tonight from being on the boards /website and reading. Thank you.
 
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