Quick Start Guide (Lantus/Levemir Edition)

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Sam and S'mores

Sam and S'mores

Member Since 2011
This post grew out of my experiences, and many helpful comments here, here and PM's. Please keep the comments coming if you see anything amiss or which can be improved. --Sam

Quick Start Guide (Lantus/Levemir Edition)


Image: AKARAKINGDOMS / FreeDigitalPhotos.net

Welcome to the Lantus Insulin Support Group.

If you have found this post, you are in one of the best places in the world to get help and much needed support in treating your diabetic cat. There is a library of information on this site, and an unparalleled group of supportive people who will help you through it.

That huge amount of support can be very overwhelming at first, and you may already overwhelmed by a recent diagnosis of Feline Diabetes. This post is an attempt to help you start in a more simplified, and hopefully less overwhelming way. This is not a substitute, and certainly not intended to contradict, any of the more comprehensive and nuanced information elsewhere on the site, but rather a simpler gateway to organize that information. In order to make this as easy as possible, a nominal recommendation will be made in every case where there are a large number of roughly equal choices. Feel free to substitute any other option after reading the more detailed posts on the subject.

The costs associated with caring for a diabetic cat are not insignificant, and can be overwhelming for many people. I have included aproximate prices so that you have some idea what to expect (these are generally US prices), but prices do vary quite widely, and it pays to shop around. Many of the supplies will last for many months, so the cost is much less on a monthly basis. If you truly cannot afford this care, there is sometimes help available from places like Diabetic Cats in Need.

OK. Preamble aside, here is the “Quick Start Guide” for someone new to Feline Diabetes control. Specifically, this is targeted at users of the insulin analog drugs Lantus or Levemir.

If at any point you have a question, or it just seems overwhelming, just POST and we will be there to help.

Step 1: You need a prescription for Lantus/Levemir and Syringes from your Vet
  • Lantus/Levemir: We recommend asking for a prescription for the SoloSTAR pen (Lantus) or the FlexPens (Levemir). They both come 5 in a box for ~200-275USD. Each pen can be used as a small vial of Lantus/Levemir, which reduces the cost and waste if and when the vial expires or goes bad. They can be purchased from almost any pharmacy, almost always with a prescription required. Occasionally you can find a pharmacy that will sell individual pens. Each pen will last for 1-3 months, or more, so while the initial cost is high, one box should last for quite a while.
    Here is more info and pictures on Lantus and Levemir: STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE
  • Syringes: You will have to use “U-100” syringes with 1/2 unit markings, we recommend 0.3cc insulin syringes. They are ~15USD for 100 (They can be found less expensively online). Many people prefer the “short” 5/16” long needles over the “standard” 1/2" length. They can be purchased from any pharmacy, usually with a prescription required. Some states do not require a prescription for needles, but even then, individual pharmacies often require them.
  • Sharps Container: In many municipalities, you need some sort of sharps waste for the syringes and the lancets (below). Many people use a needle clipper such as this. Check with your vet and/or pharmacy to find out how to properly dispose of the sharps after you fill up the container.
Step 2: You need to learn to measure your cat’s Glucose level at home
  • Supplies Needed:
  • Newbie Kit: This is one way to get started with home testing, particularly if you are struggling financially, or just completely overwhelmed. People have donated kits of testing supplies, and will happily send you a kit for just the cost of shipping.
  • Human Glucose Meter: There are many choices, most good. One of the cheapest meters and strips widely available is the ReliOn Micro from Walmart Pharmacy. It costs ~15USD, and the test strips cost ~40USD for 100.
    Most other strips and meters are just as good, so long as they need 0.3ul of blood or less.
    Spending extra for a Feline calibrated meter is generally unnecessary.
  • Test Strips for the meter: These are sometimes behind the counter at the pharmacy, but no prescription is required.
    Most strips are much cheaper online.
  • Lancet: This is the sharp pin that draws the blood droplet for the meter to read. New testers (and new cats) should start with “fatter” 25G or 28G lancets (5-15USD for 100) to use either with the Lancet Device (a.k.a Lancet Pen) supplied with the meter, or with a separate lancet device (5-20USD)
  • Other supplies: Not strictly necessary, but many people have found Neosporin w/ pain relieve (ointment NOT cream) to be helpful (see technique section below)
    Technique:
    Different techniques work for different cats, so you will need to experiment to find what works for you. You will also need practice. It will probably take a couple weeks for you and your cat to get comfortable.
    The definitive post is Hometesting Links and Tips.
Step 3: You need a kit of various emergency and additional testing supplies
  • Please Please Please put together these emergency supplies immediately, ideally even before you give the first Lantus/Levemir shot
  • Print out and POST PROMINANTLY these two posts:
    How to treat HYPOS - THEY CAN KILL!
    List of Hypo Symptoms
  • Hypoglycemia Emergency Toolkit: See this post
  • Ketone: Ketostix for ~15USD for 50 measure ketones in urine and are available at most pharmacies.
Step 4: Change to a Very Low Carbohydrate cat food diet
Caution: A low-carbohydrate diet may not be appropriate for some cats with health conditions such as chronic renal failure or pancreatitis; check with your vet to see if this diet is appropriate.
  • Even before discussing starting Lantus or Levemir, diet change is frequently critical to long-term improvement in Feline Diabetes. Specifically, transitioning to a wet food diet with <10% carb energy content is strongly recommended in this forum.
    Unfortunately, accurate values for the carbohydrate content of any given food are not readily available, but the following list is one of the more comprehensive available. Binky's Nutritional Information Page
    Here is a detailed discussion for making the transition for your cat: Transitioning your cat from dry to wet food
  • The sooner you make the transition, the easier it will be. If you transition before you have started using Lantus/Levemir, you could transition immediately (if your cat is up for it). However, after you have stabilized on Lantus/Levemir, you will need to be careful to monitor very closely during the transition to ensure that you don’t accidentally overdose as your cat’s insulin needs drop.
  • Print out the list and bring it with you to the store. You are most likely to find Friskies Classic Pate, 9-Lives Dinners, Fancy Feast (see the “old” list), and Special Kitty (Walmart)
  • Your vet may recommend a prescription diet, such as Hills M/D. These prescription diets are not nearly as low in carbohydrate content as the commercially available options, and much more expensive.
Step 5: Now you are ready to start treating your cat with Lantus or Levemir
Step 6: Some day, your cat may go into remission and be Off The Juice (OTJ)
  • Throw a big party, and enjoy.
  • Cats often go into remission, but unfortunately are never “cured”. Religiously staying on the very low carbohydrate diet can reduce the risk or rate of recurrence, but you will need to test regularly to catch any recurrence quickly.
    • Stay on the Very Low Carb diet to help keep your cat OTJ
    • But also keep testing periodically to catch any recurrence quickly: At least monthly, and any time your cat seems “off” at all.
 

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did neosporin ointment with pain relief getting added in there somewhere? i know it's not necessary, but as though it's not bad enough to poke your kitty, if their ear is in pain and their flinching from you that makes it so much worse.
 
julie1220 said:
did neosporin ointment with pain relief getting added in there somewhere? i know it's not necessary, but as though it's not bad enough to poke your kitty, if their ear is in pain and their flinching from you that makes it so much worse.
Click to expand...

Please note - with neosporin+pain relief...there are 2 mixtures of this. One's a standard 'vaseline' oil base, the other is a white cream. The oil base one works great but the cream makes the blood 'soak' into the hair instead of beading. Learned that the day I decided was time for a mini-curve - used cream after second poke - that's the last blood BEADING I got. We generally use the cream as it soaks into the skin better and quicker but in this case, it mostly defeats the purpose.
 
Thanks for the suggestion. I found the ointment critical early on, but now the blood just pops out on it's own... It's probably because he is bleeding so much more easily.
 
Very nice. Perhaps you can save this as a google doc? That way you can edit it with any changes and we can link to it.

1. I created this file a while ago which might help and have things you can add https://docs.google.com/document/d/1Rd6sMfsrNB41yQVEqpyjlHrJsDIbGEhbRIWR4QAwu3c/pub

2. Lantus pens last up to six months if kept in the fridge ( not the door) and are handled carefully.

3. Arkray models of meters are good too. The relion prime is $9 for 50 strips and the meter is $16 but it needs more blood.

4. Dont forget dr piersons updated food list : http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf I think its more up to date but Binky is good too for international and some flavours dr pierson doesnt cover.

5. we also ask people do a profile: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=79123

6. A few notes for Canadians since this board isnt just the US! : Lantus pens are $99-$125. No prescription is required for insulin or syringes. Shoppers Drug mart gives free sharps containers if you tell them you buy your insulin there - they will take back your full one and replace with a new empty one for free. You cant get the Walmart Relion or Arkray in Canada :(. The Bayer contour is free with a coupon (see the supply closet) and comes with 25 strips. Most strips in Canada are around $75 for 100 in pharmacies etc unless you try ebay. Canada doesnt sell neosporin - use Polysporin.


Wendy
 
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