Need help again with insulin questions

[Chris & China (GA)]

Hello everyone. I finally found a vet who was willing to work WITH China and I, so am very happy about that. China had been diagnosed with BG of 447 and diet change was only option given at that time, but just the diet change (to wet Friskies mostly) was bringing her readings down into the 250's, so we were headed in the right direction. Then I guess her pancreas adjusted and we went back up to 569. The new vet wanted to start her on Lantus, 4 units per day (she only weighs 8.5lbs so that sounded high) but he said I could start lower if I felt more comfortable doing that.

Now for the BIG problem...10ml of Lantus is over $150 and they say can only be used for 28days. With my income being less than $700/month, I just don't know how I can possibly afford that! The pharmacy suggested NPH, but I've learned here that it's not an insulin to use, especially at first. (but is only about $25)

Even if I started her on 2 units per day (Instead of 4), that bottle would only last 50 days (but they say must be thrown out after 28) so what are my options? I can't afford even the $150 every 50 days

ProZinc isn't available around here without special ordering (so I have no idea how much that would be) and Levimire is about the same as Lantus.

Thanks again for this wonderful message board!!

 

[Wendy&Tiggy(GA)]

hello again!

Now for the BIG problem...10ml of Lantus is over $150 and they say can only be used for 28days. With my income being less than $700/month, I just don't know how I can possibly afford that!

Good news is that the 28 day rule is more for humans who get through the vial that fast. With cats one vial lasts up to six months. I can personally attest to 4 months and many members get 6 months. But you need to keep it in the fridge (not the door). Dont shake or roll the vial, and after about 4 months keep an eye on it for floaties or cloudiness or getting less effective! Good news too - Lantus is a great insulin and gives China a great chance for regulation or even remission

Secondly, I am assuming the vet wants 2 unitsevery twelve hours? You are right, thats a lot to start with especially since you are feeding wet food. We recommend 1 unit at the most to start - given every twelve hours.

What flavours of Friskies? Some are too high carb.

Wendy

 

[Deb & Wink]

First, have your vet rewrite the Lantus prescription to be for the Lantus Solostar Pen.

Second, go here http://www.lantus.com/considering/save-on-lantus/default.aspx and sign up for the Lantus Savings Card. Print this out. Most of us do this signup in our names since we are guardians for "underage" pets. This program will cost you $25 for the first 6 prescriptions of the Solostar pen. You will need to either call around to find a pharmacy that is willing to break up a box of the 5 pens, or buy a box of 5 pens. The cost of the 5 pens with the savings card is about the same cost as a 10ml vial.

The advantage to the pen is it can be used to the last drop, where the vial often goes bad before the entire vial is used up. You will need to buy insulin syringes to use with the pen. The dial in dosing feature is not accurate enough to get a consistent dose with the pens, so we draw the insulin out of the pen with the syringe.

Third. The insulin can be kept much longer than the 28 days on the label. It is labeled that way because the manufacturer did not do any testing on the efficacy of the Lantus beyond the 28 day period. We have found that the vial of insulin can last 4-6 months with careful handling. The pens can be used until the last drop usually.

Fourth. That starting dose of 4 units, even 2 units is way too high. Most cats need no more than 1 unit to start. If you follow your vets advice on the dosing, you are likely to hypo your cat. Starting dose calculation 8.5 pounds / pounds in a kilo = 3.86 kilos
3.86 Kilos * 0.25Units per kilo = .965 units of insulin.
Rounding down for safety gives us 0.75 Units of insulin to start.

 

[Carl & Polly & Bob (GA)]

Hi Chris,
If your vet wants something other than "crazy internet cat people" as a reference for dosing, share this link with them.
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

Most cats are well regulated on insulin at 0.5 U/kg q 12 hours, with a range of 0.2 to 0.8 U/kg.
The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight.
This equates to 1 U q 12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours.

Like Deb mentioned, with China's current weight, just under 1u would be logical, so 1u twice a day would be the highest that makes sense.

It's a lot easier, and much more safe, to start at a lower logical dose and work your way up if the numbers show you the dose is too low. Once insulin is "in", you can't take it back "out", and an overdosed cat is a million times more difficult to manage than an underdosed one is. High BGs while not good can cause damage over the long term, and slowly. BG numbers that are too low can do irreparable damage within hours. (Translated - "Hypos can kill")
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

 

[Chris & China (GA)]

Thank you so much!! I'll check into the Lantus Savings Card as well as calling around to see if I can find a pharmacy that will split up the pens

Also I really appreciate your thoughts on dosing....After spending a lot of time reading in here, when he said he wanted to start her on 4 units once/day, I was pretty freaked out. He did agree I could start lower (the 2 unit dose per day), but he seemed to think it wouldn't do much and we'd have to increase her.....but even 2 units on such a small kitty still seemed awfully high.

I will let him know I'm only comfortable with starting her on .75 units, but he's only talking about once/day dosing..should it be .75 once or twice a day? (with BG tests before each one)

Dont shake or roll the vial, and after about 4 months keep an eye on it for floaties or cloudiness or getting less effective!

With this, again I'm getting opposite stories...He made a big deal out of not shaking the vial, but rolling it to mix, saying without mixing it, the doses from a new bottle would be weaker (have less of the protein needed), while when we'd get to the end of the bottle, it'd be too concentrated...seems reasonable to me, but you're saying it's not a good idea

What flavours of Friskies? Some are too high carb.

Friskies Super Supper, Turkey&Giblets and Ocean Whitefish pate's only..no gravies/sauces. Also only pate' versions of Fancy Feast

I looked over a great spreadsheet that had all the foods broken down into protien/fat/carbs etc. but I don't seem to be able to find it again. I think it was Dr. Lynne's Wet Food Shopping List but I'm getting "Sorry, the page you requested doesn't exist, or has moved." when I try to open it today

 

[Chris & China (GA)]

And Thank You Carl and Bob for not only the link, but the giggle...."crazy internet cat people"....hahahaha :lol: (I have seen a lot of deep sighs and eye rolling when I mention this message board, but this new vet seems interested in learning and may even do a little research here

And yes...I told him I was more comfortable with "Low and Slow" but he still recommended the 2 units once/day...which is why I'm talking to you wonderful people...crazy or not...lol

 

[Deb & Wink]

With this, again I'm getting opposite stories...He made a big deal out of not shaking the vial, but rolling it to mix, saying without mixing it, the doses from a new bottle would be weaker (have less of the protein needed), while when we'd get to the end of the bottle, it'd be too concentrated...seems reasonable to me, but you're saying it's not a good idea

Some insulins do need to be mixed with rolling. Any insulin that is a suspension and is cloudy needs to be rolled to remix the insulin. Humulin, Novolin, Vetsulin, Caninsulin, PZI, Prozinc all need to be gently mixed to resuspend the particles in the vial.

Some insulins do NOT need to be mixed or rolled. They are not suspensions. There are no distinct particles in the vial. These are the clear insulins like Lantus and Levimir

 

[Chris & China (GA)]

Prozinc all need to be gently mixed to resuspend the particles in the vial.

The new vet is more experienced with the Prozinc but we can't get it without special order around here, so he may not understand the differences. Since Lantus and Levimire are both easily available, he's willing to try the Lantus

Thanks for letting me know...I'll continue to "teach" him (since he seems willing to listen/learn) as we all go through this adventure

 

[Deb & Wink]

I looked over a great spreadsheet that had all the foods broken down into protien/fat/carbs etc. but I don't seem to be able to find it again. I think it was Dr. Lynne's Wet Food Shopping List but I'm getting "Sorry, the page you requested doesn't exist, or has moved." when I try to open it today

I believe that link is broken.

Try this one. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

This is a food chart created by a very dedicated vet, Dr. Lisa Pierson, who is really concerned about feline nutrition. The chart was updated in September 2012 so is very current. Look in the third column of numbers for the Carb percent and stay under 10% for the best results.

There is also a short cut shopping list member Rhiannon and Shadow have done up, Takes all the foods from the Pierson food chart and lists them, with a phosphorus content for those kitties that may need lower phosphorus due to kidney issues.

 

[Carl & Polly & Bob (GA)]

:lol: I was going to say "crazy cat ladies" but there are a few of us guys around!

Yes, PZI/Prozinc and others do need to be rolled to "mix" the suspension before drawing up the insulin, but Lantus does NOT need to be. I used PZI, and when I first started reading the threads of Lantus users, and how it wasn't supposed to get rolled, or shaken, and it should be kept in the fridge but NOT on the door in case people slammed the fridge drawer, I used to think "Well what is this stuff, nitroglycerin or something? Is it going to explode if you push the plunger too fast?" :lol: Then I learned about the difference between the types of insulin and it made sense to me.

 

[Deb & Wink]

I used to think "Well what is this stuff, nitroglycerin or something? Is it going to explode if you push the plunger too fast?" :lol:

No, the darn stuff is just so expensive, we treat it with the utmost of care to get it to last longer. At $170-180 a pop for a 10ml vial, you bet we treat it like nitroglycerin. Or liquid gold perhaps. ;-)

I also wrapped a paper towel around the vial, stored it in it's original box, on a lesser used frig shelf inside a coffee mug and very carefully took the mug out of the fridge to use this. That was because I have tile floors in the kitchen and have dropped too many dishes on that rock hard floor and shattered them. I wanted that little bit of extra protection in case I fumbled the vial.

 

[Wendy&Tiggy(GA)]

I will let him know I'm only comfortable with starting her on .75 units, but he's only talking about once/day dosing..should it be .75 once or twice a day? (with BG tests before each one)

Lantus has the best effectiveness dosed twice a day since it only lasts 12 hours in cats. I know I have seen a vet journal article on this too but I can't find it now.. Carl??

So I would give 0.75 every 12 hours to see how that goes.

 

[Larry and Kitties]

You said "Even if I started her on 2 units per day (Instead of 4), that bottle would only last 50 days (but they say must be thrown out after 28) so what are my options?" You missed a decimal point. The 10 ml vial contains 1000 units of insulin. At 2 units per day that is 500 days.
Each pen is 300 units. So at 2 units/day that would be 150 days/pen

 

[Chris & China (GA)]

You missed a decimal point. The 10 ml vial contains 1000 units of insulin. At 2 units per day that is 500 days.
Each pen is 300 units. So at 2 units/day that would be 150 days/pen

Oh WOW...Thanks for catching that!! The pharmacist told me wrong too!! I seriously doubt if the Lantus would last long enough to get 1000 units before having to throw it out, but the pens look like a great idea...especially since we're now thinking more along the lines of starting at .75-1 unit twice/day. If that ends up being enough, one pen would last 5 months

 

[Wendy&Tiggy(GA)]

My math says she can start on 1unit but you might want to do with 0.75 since she is small... every 12 hours.

 

[Carl & Polly & Bob (GA)]

Lantus has the best effectiveness dosed twice a day since it only lasts 12 hours in cats. I know I have seen a vet journal article on this too but I can't find it now.. Carl??

http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

Initiate insulin therapy with PZI or insulin glargine at a starting dose of 1 U per cat q 12 hours.

...

Most cats are well regulated on insulin at 0.5 U/kg q 12 hours, with a range of 0.2 to 0.8 U/kg.

The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight. This equates to 1 U q 12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours.

In the AHAA guidelines, they repeatedly say every 12 hours. I can't see anywhere in the guidelines that says "once per day".