REALLY Confused About A Vet's Insulin Suggestion

[AvalonWitch]

*Title now refers to the post I just made, 4/11/2012*

For Background

First Thread: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=67857
Second Thread: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=68213

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I decided to "curve" Shiro at home over the course of the day, just to see where he ranges throughout the day. He is NOT on insulin. These results are after a little under one week of switching to a low-carb, canned-food only diet. I want to know what you guys make of this, and also if you think his numbers are likely to drop any further after another week or two of the diet or if this is as good as it should get. Last saturday, when his diagnostic bloodwork was taken (at approximately noon) Shiro's Glucose was at 640 mg/dl. He also had trace Ketones and high cholesterol (228).

8am (Before Eating) 362 mg/dl
8:45am (Immediately After Eating) 429 mg/dl
9:45am (Aprx an Hour After Eating) 395 mg/dl
1pm (Before Eating) 308 mg/dl
***2pm (Apprx an Hour After Eating) *Didn’t Eat Much 268 mg/dl*** (see note below)
4pm 213 mg/dl
6pm (Before Eating) 243 mg/dl
7pm (Aprx an Hour After Eating) 254 mg/dl
9pm 278 mg/dl
10pm(Before Eating) 362 mg/dl
10pm (Immediately After Eating) 329 mg/dl


**Shiro did not eat much at his 1-2pm feeding. Less than half of half a can of Fancy Feast Classic. I tested his blood twice at this reading, the first test came back at 262 and the second came back at 268.


He handled it all like a champ and only growled twice. I don't plan on doing this again for at least another week - though i'll probably take some am and pm feeding tests every few days this week and maybe one mini curve. Thoughts? I have no idea what to make of these numbers! I know they aren't great but they also aren't where they were last week.


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Edit :

After reading kimouette and Gayle Shadoe & Oliver's results I became quite distraught. ESPECIALLY after finding out that my mother decided to feed Shiro some more dry kibble because she was "too tired" to open a can. On the way to school I had a conversation with my father. I explained to him that if Shiro's numbers don't drop another 100 points by this weekend, I'd like to take him in for a curve and get him prescribed insulin. I expressed the belief that if diet alone was going to regulate Shiro, his numbers would drop. And that if we left this alone for another two weeks to a month - he would die. He shrugged and said "fine." Thus i've contacted Shiro's regular vet, the same one who insisted on a three day curve. Although she won't talk to me directly, the vet tech told me this is what she (the vet) wants to do.

Essentially, she wants to call in an injectable insulin for us to pick up at our pharmacy. They mentioned it was expensive and that there was no "pen" version but they wouldn't give me a name; i'd have to get that information from the pharmacy AFTER they call it in. They said that Shiro would need to be on that insulin for 7 days BEFORE they hospitalized to curve him, at which point I assume they would alter his insulin as necessary.

Any thoughts on this move? I'm getting a consult via email from another vet in our area but it's you guys to whom I look for - as you have all the experience and I have none. I'll be trying to squeeze the name of the insulin out of the vet tech when I call her back with our pharmacy's number.

 

[grapey]

Re: First "Curve" - No Insulin

You're asking the exact question I was asking a couple of weeks ago! And, unfortunately, for Lily, diet alone wasn't enough. Her glucose did drop about 100 points in the first week on high protein wet food (Purina DM), but for the second week, it didn't drop any more and in fact went higher a couple of times. I did not want to put her on insulin, but I came to a point where I realized diet alone wasn't working and the vet agreed.

I would be very hesitant to wait too long to see if the diet alone works, mainly because of your high numbers. Lily's highest was 350-ish, so I felt OK waiting two weeks to see if the food alone would work. But I did not feel comfortable waiting a third week (like the vet initially suggested). Thank God for home testing, or else I would have been totally in the dark!

 

[kimouette]

Re: First "Curve" - No Insulin

First of all congratulation! Are you a nurse or something? Most of us can barely get a drop of blood the first time we try to test our cat! And you, well you tested 10 times on your first day!

Follow the procedure in the following thread if you want to start a spreadsheet that will tell you if the bg levels are high or low (shown by the color ranges):
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

And as a guideline :
http://en.wikipedia.org/wiki/Diabetes_in_cats#Blood_sugar_guidelines
*As you will notice on that chart, your cat's BG levels are most of the time, pretty high. First thing I would do if I were you is to check for Ketones (with Ketodiastix urine strips).

The readings right after eating are the ones that would concern me.

Option 1 : Keep on testing after each meal to see how high the numbers are (to see if they are the same everyday or if they vary from day to day)
Option 2 : Ask your vet for a soft, long lasting insulin like Lantus and start with very low dosage to keep your cat regulated at safe BG levels

:?: What exact food are you giving your cat and what amount daily

I completely understand that you want to keep your cat off insulin as much as possible and treat his sugar problem with food cuz it's a healthy and natural choice. But you really need to understand that an untreated diabetes can lead to important neuropathic problems, or even worse...
It's probable that your cat will need insulin in small dosage and maybe for a very short period of time, but it's important not to ignore the insulin need, if it's the case.

 

[AvalonWitch]

Re: First "Curve" - No Insulin

@ Grapey - I, personally, don't expect Diet to be enough. But it's my parents that control where Shiro's treatment goes and unfortunately any attempt to push them towards something other than what they want (a month of diet and THEN insulin IF necessary) will result in the cat being put down or me getting kicked out (which would result in the cat dying slowly from diabetes.) Logic, emotion, nothing really plays a role in their decisions other than their own stubborn whims. Both have Borderline Personality Disorder and are unmedicated. I'd love to put Shiro on Insulin right now but it's just not something they're willing to do until after the long term diet results show he is not well enough controlled. Unfortunately - I work for them and they're funding my law school without charging me rent so my chances of getting them to budge are the chances that Mr. Fuji will pick up and do a little jig for us.

@ kimouette - Regarding the reasons behind Shiro (currently) not being on insulin, you can see my response to Grapey above. XD Thanks for the compliment. I have the thread to thank really. I knew what meter I would like, what gauge (30g), the rice sock trick. Shiro of course helped out immensely. He's normally a TERRIBLY grumpy, violent guy with a mean disposition. But he sat still for all but two of the tests (and slept through one). He tends to get like this whenever medical things are involved - it's a blessing in disguise really.

Shiro's glucose was well over 600 last week. I'm really hoping that a continue diet will continue to knock him down a few pegs. If they don't, in two weeks or so I will be pushing for a one day vet-done curve and an insulin Rx. Two of his after-eating readings were higher than the before-eating readings. But two were lower...which confused me. Granted, his appetite has decreased since we started him on his diet. Unfortunately, he's a fan of hard food and treats and so a wet diet makes him finicky.

We feed him Fancy Feast Classic-style canned food. Four cans a day, approximately 4-5 hours apart. He weighs approximately 13lbs so the four can ration is about 1/4 can more than the suggested serving...but he has yet to actually EAT an ENTIRE serving at any meal so he ends up eating a bit less than what is recommended. We usually give each meal to him divided in half, in case he passes up half a can we try again later in the hour with a fresh half (we give the other half to one of his two brothers.)

 

[kimouette]

Re: First "Curve" - No Insulin

I cant believe I'm about to say this... but.... Could you secretely give your cat insulin and wait a month before pretending it's the first time you do it? Or could your cat stay at a friend's house or something to receive his treatment?
With a little bit of luck one month could even be enough for your cat to go into remission... And if not, then just pretend your cat finally needs insulin.

Right now I wouldn't say it's a matter of life and death cuz you still haven't tested for more than a day, but if you do keep on getting high results like this and never allow the cat to stay at safe values most of the time, the result will be exactly the same as if your parents kicked you out : he will slowly die from his diabetes.


This is unbelievable. Your parents definately dont understand what they are inflicting to the poor cat
And what if the vet spoke to your parents directly? If you show the numbers to your vet she will agree with an insulin treatment and maybe be persuasive enough to your parents?

 

[Blue]

Re: First "Curve" - No Insulin

@ Grapey - I, personally, don't expect Diet to be enough. But it's my parents that control where Shiro's treatment goes and unfortunately any attempt to push them towards something other than what they want (a month of diet and THEN insulin IF necessary) will result in the cat being put down or me getting kicked out (which would result in the cat dying slowly from diabetes.) Logic, emotion, nothing really plays a role in their decisions other than their own stubborn whims. Both have Borderline Personality Disorder and are unmedicated. I'd love to put Shiro on Insulin right now but it's just not something they're willing to do until after the long term diet results show he is not well enough controlled. Unfortunately - I work for them and they're funding my law school without charging me rent so my chances of getting them to budge are the chances that Mr. Fuji will pick up and do a little jig for us.

@ kimouette - Regarding the reasons behind Shiro (currently) not being on insulin, you can see my response to Grapey above. XD Thanks for the compliment. I have the thread to thank really. I knew what meter I would like, what gauge (30g), the rice sock trick. Shiro of course helped out immensely. He's normally a TERRIBLY grumpy, violent guy with a mean disposition. But he sat still for all but two of the tests (and slept through one). He tends to get like this whenever medical things are involved - it's a blessing in disguise really.

Shiro's glucose was well over 600 last week. I'm really hoping that a continue diet will continue to knock him down a few pegs. If they don't, in two weeks or so I will be pushing for a one day vet-done curve and an insulin Rx. Two of his after-eating readings were higher than the before-eating readings. But two were lower...which confused me. Granted, his appetite has decreased since we started him on his diet. Unfortunately, he's a fan of hard food and treats and so a wet diet makes him finicky.

We feed him Fancy Feast Classic-style canned food. Four cans a day, approximately 4-5 hours apart. He weighs approximately 13lbs so the four can ration is about 1/4 can more than the suggested serving...but he has yet to actually EAT an ENTIRE serving at any meal so he ends up eating a bit less than what is recommended. We usually give each meal to him divided in half, in case he passes up half a can we try again later in the hour with a fresh half (we give the other half to one of his two brothers.)

The diet has reduced the numbers but not near enough. Shiro's not one of the diet controlled cats at all by the looks of his numbers.

He is starving because his diabetes is unregulated. Diabetic cats eat a great deal more because they are incapable of extracting the nutrients from the food. When he becomes regulated when he is on insulin, he will eat much much less. My Oliver was eating around 30oz a day before he was regulated... that's TEN cans of fancy feast a day.... he's down to a third of that amount. By withholding insulin, Shiro is being starved inside, and his high numbers could be affecting his appetite as well... if he feels horrible, he may not be up to eating when food it put in front of him.

Curves at the vet result in data of little use. Majority of animals are stressed at the vet office and their stress is reflected in their BG numbers, therefore your 'one day vet-curve' is going to give you even higher numbers than you are seeing at home. You are already home testing so the expense of the curve could be put to better use right now by getting the insulin and starting injections.
Ask the vet how much the curve will cost compare that to the cost of insulin that could last you for 6months. I bet those two costs may be an eye opener to your parents... you take your cat to the vet and leave him for the day.
The vet does a curve, testing Shiro a handful of times, and charges you $100 and says "he needs insulin."
OR
You can get a pack of 5 pens of Lantus for around the same price, and Shiro has enough insulin for over 6months.
There are many others who are not diet controlled before insulin, just like Shiro, but after a few weeks and months on insulin, their pancreas becomes strong enough to function without insulin....many cats can go in remission if started on insulin soon enough, but waiting too long, allowing the pancreas to get sicker, just lessens your chances of getting off insulin.

It's like walking on a broken ankle.... put the cast on now and let the ankle heal or delay taking action and walk around on the ankle until you end up having to have surgery on the ankle and may never be able to walk normal again.

See if you can get the prices from the vet for the cost of the curve, and people here can help you to find the most inexpensive sources for insulin like Lantus. The food situation will change as well because it's been only a week on wet food and Shiro will get used to it, then eat less one he's regulated on insulin. I am sure that the cost effective route is to start insulin now because a vet curve is a waste of money.. your meter should have an average of your tests which will be more true than the vet curve.

 

[BJM]

Re: First "Curve" - No Insulin

Your parents like to be in control, so what would help them make the decision the cat needs insulin? If you happened to print out some material on feline diabetes and left it around, would they read it and come to the decision themselves?

And I'm wondering if it would help you to learn some advanced communication skills to help navigate conversations with them, which have got to be tough for you. "The Gentle art of Verbal Self-Defense" by Suzette Hayden-Elgin is pretty good, as is "Tongue Fu" by Sam Horn, if you can get them (maybe Amazon.com ?). They do NOT use direct confrontation, which will not work with your parents. Er.. don't leave books like that where they can find it!

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

@kimouette, Gayle Shadoe & Oliver - Thank you for your advice. In the case of my family going about this behind their backs would result in ... retribution. Of the most severe kind and so that is not an option. I invite you both to read the edit I made to the post above and let me know what you think? It's a step in the right direction but now i'm just scared about the insulin.

@BJM - That's exactly what it is. Unfortunately, neither of my parents are the reading type. My mother is fully illiterate in both Spanish and English and my father works an 18 hour day, sometimes longer. Haha! I actually have both those texts. I also have Walking on Eggshells which specializes in dealing with BPD family members, and several other print outs from my therapist. I also invite you to read my above edit and let me know what you think. Catching my dad while he was feeling guilty about Shiro having eaten hard food (he didn't know and was mildly irritated at my mother - Shiro is primarily "his buddy") and while in a good mood really was a miracle. I'm eternally thankful but i'm worried that the vet's suggestion is so different from the plan he agreed to.

 

[Melanie and Smokey]

Re: Confused About a Vet's Insulin Suggestion

Most of what your vet is saying sounds normal to me.

A curve is done to determine the effects the insulin is having on the cat so doing a curve at the vet's before starting insulin will most likely be a waste of money. A fructosamine test would tell you if a food change is doing what's needed because food changes wouldn't have the possible wide swings that insulin can do that make fructosamine tests not as useful. The idea of waiting a week after starting insulin is that the insulin typically needs a week to settle, before that the changes are going to be erratic as their body gets used to it and they wouldn't adjust the dose during that time unless he was unsafely low - so running a curve before the end of that week would not provide any benefits. During that week you'd definitely want to hometest.

Many vets do not know that the pen form of insulins can be used the same way as a vial and their literature says that the pens should not be used on cats, that could be why he is saying the insulin is not available in a pen form, because its not available in a pen form that can be used on cats. He may also just be unfamiliar with all the ways it comes available for humans since he prescribes it for animals.

Some cats that can be diet controlled do so with just a diet change. Most need both the diet change and a short time on insulin to help their pancreas get functioning correctly again. Sometimes it is just a very short time on insulin before the diet change can manage the low numbers alone. The longer the kitty is left to struggle in the high numbers without any insulin, the more damage is done to the pancreas so maybe you could convince your parents that the best possibility to get him off of the insulin quickly is to get him on it quickly?

 

[BJM]

Re: Confused About a Vet's Insulin Suggestion

Essentially, she wants to call in an injectable insulin for us to pick up at our pharmacy. They mentioned it was expensive and that there was no "pen" version but they wouldn't give me a name; i'd have to get that information from the pharmacy AFTER they call it in. They said that Shiro would need to be on that insulin for 7 days BEFORE they hospitalized to curve him, at which point I assume they would alter his insulin as necessary.

Any thoughts on this move? I'm getting a consult via email from another vet in our area but it's you guys to whom I look for - as you have all the experience and I have none. I'll be trying to squeeze the name of the insulin out of the vet tech when I call her back with our pharmacy's number.

The vet should be prescribing insulins known to work well in cats: Lantus, Levemir, ProZinc, or PZI. If She prescribes Humulin N or a variant, she is likely NOT up to date on treating feline diabetics. If you are getting it from a human pharmacy and there is no pen, which both Lantus and Levemir have, it may be something not tested in cats yet. I'd suggest making known a request for Lantus or Levemir due to the documented success in cats, which surely she would know about if she was up to date.

Not having a pen isn't too big a deal, other than longevity of the opened insulin. When you use only 2-4 units a day, a 1,000 unit vial covers 250 days, but may start to become slightly less effective towards the end. You can compensate by using a tiny bit more - your glucose test numbers will direct your dosing. With pen or vial, you'd still use an insulin syringe to withdraw the insulin, too.

And, you can do the curve yourself, as you just proved. No need for expensive veterinary hospitalization. Vet won't like that, but tough! The results are more valid at home, since there is no vet stress.

Also, when/if you get the insulin, you may want to start around 1 unit per dose, every 12 hours, and on a day you can be observing and testing, just in case the 1 unit turns turns out to be a bit high. Most often it is not, but safety first. If you get Lantus, you can go to that forum and read up on how it works, the protocol for managing doses, and how to safely give insulin when the cat gets into lower numbers (less than 200, at first, then 150 once you have collected repeatable data on how your cat responds.)

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

I would call the vet and tell them you want the name of the insulin before picking it up. Both Lantus and Levemir come in pen form, and if your vet is prescribing a human insulin other than one of those two, you don't want it. I'm concerned that your vet is giving you a prescription for Humulin N (NPH), which does not work well in cats and is unsafe in comparison with the other two.

If it was Humulin N, ask the vet for a script for one of the "L" insulins instead. If your vet refuses, then you may need to find a new vet. From what you've described so far, this vet doesn't seem very current with feline diabetes treatment. So the real question is whether or not you can get this vet to work with you--if not, it's time for someone who will. Here's a link to the AAHA diabetes guidelines for you to print out and give to your vet: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. See p. 4 (218) where is says Insulin Therapy in the Cat if you need proof to show your vet. Humulin N works very similar to the lente insulin described. Also look under Precautions and Details where is says Home testing is preferable to office testing.

This has been said multiple times now, but you do not need a curve done at the vet if you are home testing. Testing at the vet is not as accurate as home testing because stress raises blood sugar levels, and more often than not leads to overdosing. Also, dose adjustments should be made based on daily testing, not weekly. I have never once paid for any blood sugar testing at the vet. However, my vet also told me I HAD to home test from the get go because office curves were too unreliable and infrequent, so I was fortunate to have that information from the start.

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

@ Melanie and Smokey - That definitely makes sense, the insulin needing to settle in his system. I'll discuss the necessity for a hospitalized curve when we actually see the vet. If I can convince her that I can do it myself and then just send the numbers her way so she can advise an adjustment then I don't see why she would disagree unless she felt I wasn't capable or had some other motive (what would that be, do you think?)

@ BJM & Julia & Bandit - I called the vet and told them that I needed the name of the insulin because we needed to get a quote from the pharmacy before picking it up. The vet tech then told me that the reason they can't give us the name is because they want to know which insulins are available AT the pharmacy so that they can pick from the choices available. I provided them the number and asked if they would call me back with a selection or THEIR selection and they promptly hung up. I'll call back in a few hours to see = __ =

I have a strong feeling that the vet is going to prescribe Humulin N...maybe it's the poor technique she's shown so far in terms of suggesting a 3 day curve was THE ONLY way to get my cat treated and that he'd die without it, or the week of calling nonstop with not ONE call back. If she does I will either try to get her to switch it to Lantus or PZI (both of which i've read up on and seem to have the most info available about them) or tell my family it's time to find a new vet. In fact, I think i'll start looking into that option now. They'll love that, they hate vets and are convinced they're all frauds so anytime I appear to be upset at a vet is great for them.

I am using the possibility of a one day curve at the vet as a lure mostly. I think that after a week on insulin I would arrive at the vet with Shiro in hand, having tested him throughout the week and with my curve from this sunday in hand and suggest that I can do it at home. If she fights me, I'll privately discuss the option of moving onto the second vet with my dad. Shiro's rocket high numbers from just a 15 stay getting blood taken makes me think his numbers will be all but useless if taken anywhere but in the comfort of his home. Shiro's tolerance of 10 different tests in one day really boosted my confidence in regards to curving him myself - rather than at the vet's. Now I just have to convince the vet and my father. I'll post again when I get word on what insulin the vet wants to prescribe and also when I speak/see her to discuss home-curving him at the end of the week instead of paying her to do it =w=

One sticking point for me is that she (the vet and the vet tech) have yet to ask for my home testing numbers. What would they base this insulin Rx on? Is it, as BJM suggested - going to be at a super low dose and increased as necessary? I assume this is the safest route and so i'm all for it if that's an acceptable assumption. If there's something wrong with her not wanting to see the numbers please let me know.

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

The vet tech then told me that the reason they can't give us the name is because they want to know which insulins are available AT the pharmacy so that they can pick from the choices available.

Ummm...a pharmacy can get any human insulin they decide to prescribe, so that is a very sketchy response. Honestly, I think I would shop for a new vet at this point. What do they plan on doing to choose an insulin--call the pharmacy and ask for a list of choices, and then close their eyes and point at one for you? Instead of admitting they don't know something and performing a 5 minute google search to get a little background information, they are making stuff up to tell you. That is scary to me. Unless they cooperate and start a better dialog with you (instead of all this secretive nonsense), I'd be outta there.

But yes, you want to start at around 1u for a dose, and raise slowly based on .25u-.5u increments. Depending on what insulin you get, there are dosing protocols that you follow that tell you when to raise or lower the dose. The Lantus (or Levemir) Tight Regulation Protocol has an 84% remission rate in cats. If you're curious, check out this sticky in the Lantus TR forum.

 

[Blue]

Re: Confused About a Vet's Insulin Suggestion

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Edit :

After reading kimouette and Gayle Shadoe & Oliver's results I became quite distraught. ESPECIALLY after finding out that my mother decided to feed Shiro some more dry kibble because she was "too tired" to open a can. On the way to school I had a conversation with my father. I explained to him that if Shiro's numbers don't drop another 100 points by this weekend, I'd like to take him in for a curve and get him prescribed insulin. I expressed the belief that if diet alone was going to regulate Shiro, his numbers would drop. And that if we left this alone for another two weeks to a month - he would die. He shrugged and said "fine." Thus i've contacted Shiro's regular vet, the same one who insisted on a three day curve. Although she won't talk to me directly, the vet tech told me this is what she (the vet) wants to do.

Essentially, she wants to call in an injectable insulin for us to pick up at our pharmacy. They mentioned it was expensive and that there was no "pen" version but they wouldn't give me a name; i'd have to get that information from the pharmacy AFTER they call it in. They said that Shiro would need to be on that insulin for 7 days BEFORE they hospitalized to curve him, at which point I assume they would alter his insulin as necessary.

Any thoughts on this move? I'm getting a consult via email from another vet in our area but it's you guys to whom I look for - as you have all the experience and I have none. I'll be trying to squeeze the name of the insulin out of the vet tech when I call her back with our pharmacy's number.

It sounds like yr Dad will be on board and I am sure he does not want to have the cat starve and die. I agree with you to do everything above board and use discussions, logic and proof to state your case.

I wonder if you can explain to yr Mom that feeding the dry food is like giving peanuts to someone with an allergy to them. It is dangerous and causes harm to the cat.

If your current vet wants a 3day curve, just say no problem because it will be FREE, right? Of course the vet will say NO! to which you can reply, but there lies the difficulty.... you are but a mere starving student and cannot afford a costly hospital stay for testing. Inform the vet that you have already started home testing which will give you TRUE BG numbers and will not cause horrible stress to your cat. There is NO WAY that a correct dose can be determined by a 3day curving at the vet.... ask how much that 3 day visit would cost... I would love to know how much money they are trying to get out of you.

The vet has to give you the prescription to take where you want to fill it; it may not be convenient for you to go to the pharmacy that your vet picks. Get the name of the insulin; Glargine, or Detemir, maybe. If it were PZI / Prozinc then your vet should have that insulin in office I had thought; it's an animal insulin, whereas Lantus and Levemir are human insulins...

Sorry, your vet seems to think that the cat is not yours and you are not the one with the money to be paying the vet. Just WHO is the customer here and WHO is providing the service. I do believe that it is YOUR cat and YOUR money, and would you put up with a human dr who treated YOU like that?
Tell the vet you want the name of the insulin, the pharmacy, and the price at that pharmacy. You will want to know the dosing info and you will start when YOU are ready. YOU will select the pharmacy because pricings are diff all over. A perfect example is Walgreens charged a lady $77 for some insulin that could be had at Walmart and some other places for $26 or $44, so yes, YOU will select your own pharmacy to fill the prescription.

I am hoping the other vet will be better, surely there can't be another vet by you who is so inflexible and uncaring.

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

Sorry, your vet seems to think that the cat is not yours and you are not the one with the money to be paying the vet. Just WHO is the customer here and WHO is providing the service. I do believe that it is YOUR cat and YOUR money, and would you put up with a human dr who treated YOU like that?
Tell the vet you want the name of the insulin, the pharmacy, and the price at that pharmacy. You will want to know the dosing info and you will start when YOU are ready. YOU will select the pharmacy because pricings are diff all over. A perfect example is Walgreens charged a lady $77 for some insulin that could be had at Walmart and some other places for $26 or $44, so yes, YOU will select your own pharmacy to fill the prescription.

I couldn't agree with this more!!!!!

 

[Melanie and Smokey]

Re: Confused About a Vet's Insulin Suggestion

I misunderstood, I thought you were asking the vet for the curve and the vet was saying wait - the vet is insisting there is no way to do this without your cat staying there for a multi-day curve? Yes, unfortunately you have an old-school vet it sounds like. There is simply no reason for a cat that is home-tested to have a curve done at the vet's office. The cat is under more stress (altered BG numbers) and there is nothing they are going to do differently, the insulin shouldn't be adjusted at each dose anyway. Just tell them no, you will do the testing at home and provide them with the numbers.

I would also make it clear what insulins you WILL NOT pay for. If they are being difficult and refuse to give you the name of what they are prescribing, just tell them you are not comfortable using Hum-N and if that is the only one available at the pharmacy (just in case they try to lie and use that as an excuse) you will find a different one and that you are only confortable using ________ and name whatever insulins are acceptable to you. Since Lantus is one of the most used insulin for humans too now, I don't think they can try to say a pharmacy doesn't sell it.

Money always talks. Tell them what you will and won't pay for.

What would they base this insulin Rx on? Is it, as BJM suggested - going to be at a super low dose and increased as necessary?

Almost all cats are started the same way - 0.5 to 1.0U to start, adjusted after a week. Some vets will dose based on weight, but usually no more than that 1.0U. The type of insulin used isn't usually determined by the numbers. My vet won't use anything but Lantus on a newly diagnosed cat because of its high success rates of remission in the newly diagnosed. Some vets start all cats on one of the P insulins because they are the best insulins sold in a vet's office right now (Lantus and Lev are used off-label).

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

@ Julia and Bandit - I've gone ahead and forwarded all my information to the only vet that's been relatively helpful in this entire mess. Hopefully i'll hear back from them by the weekend. Unless I hear back from my current vet with a script for Lantus or PZI I feel kind of uncomfortable having her take care of this diabetes. As it is i'm not a fan of the total lack of communication when it comes to this issue.

@ Gayle Shadoe & Oliver - I think my father will be on board so long as it requires no effort on his part. And it really will have to require no effort no my mother or father's fault or we'll be back to square one. I'm hoping to teach my sister how to monitor tests as I work and go to school full time (both) and do not actually see this cat the majority of the time (i'd say an hour or two a day, and only longer then that one day week.) My mother fed me food I was allergic to until I was old enough to refuse to eat it, when I say she really doesn't submit to logic...I really, really mean it. 'nuff said.

Oh, they wanted $800 USD for the 3 day curve. $150 for a one day. I'm starting to believe my dad on this one. Unfortunately, they not only know that I have a steady income but that my family does as well - they are also keen on taking advantage of my dad's soft spot for this particular cat.

As far as pharmacy selection - they asked me for the name and number of our local pharmacy. I assumed they'd call back with prices but that was 11am and it's been 9 hours with no call back.

The problem is that the cat ISN'T mine and while I am paying for half, I am not the one that gets to choose whether or not we pay. The customer is my father and he's taken a very lax approach to this whole matter. He's trying to keep my mother happy (aka: she doesn't have to feed, test or inject him) and he's not really willing to do any of those things either. But you couldn't be more right - I've gone ahead and requested a consult from another local vet. I'll keep my fingers crossed on getting an email back but if not i'll give them a call and ask them to please look at my information. If I don't hear back from the current vet with an Rx for something OTHER than humulin-n by tomorrow I will make the switch.

@ Melanie and Smokey - The vet -was- insisting there was no way to do it other than a multi-day curve. After I requested a copy of the labwork and informed the tech who gave them to me that I was home testing they suddenly changed their tune. I'm COMPLETELY unwilling to toy with Shiro's life by putting him on Humulin-N and if they try to pass that onto me I will make it clear. Luckily, a pseudo dramatic angry rant made my father feel I was "on his side" and so he's more willing to switch vets, put him on insulin, etc. I'll keep my fingers crossed for Lantus it seems like the best bet.

 

[Blue]

Re: Confused About a Vet's Insulin Suggestion

Sounds like everything is proceeding quite well; good job!
You can always tell the vet that an every day testing is much better than just a few days. If a vet wanted to charge me $800 for a curve, I would run like the wind from that vet!
I hope all goes well with the new vet.

Any vet can write a prescription for you to have, be sure it's for pens or cartridges, and not a vial, and then you can purchase at the cheapest place.. many people order online, tell your vet you want the paper yourself so you can shop around.

 

[ellenr319]

Re: Confused About a Vet's Insulin Suggestion

You know, there is an organization called Diabetic Cats in Need. I bet they would help you out with getting insulin and other supplies for your cat. It is usually a very streamlined process to get them to help. Then, If you tell your parents that the insulin is not going to cost them anything, they might not balk at putting your cat on insulin sooner rather than later. Also, telling them that delaying the insulin may cause problems that will cost a heckuva lot more than insulin, may help persuade them. Good luck.

 

[kimouette]

Re: Confused About a Vet's Insulin Suggestion

I've gone ahead and requested a consult from another local vet. I'll keep my fingers crossed on getting an email back

Great!!! :thumbup

Why not call a new vet instead of writing?
Since you know what you want or do not want from a vet, maybe it would be a good idea to call vet clinics to explain the whole situation...
Start by explaining that you have a diabetic cat but you already know how and want to keep on testing his BG at home! Then ask if they would be able to get some Lantus insulin for your cat and how much it would cost for a fructosamine test (that you could plan to do in about 14 days). They'll understand that they're about to deal with a determined customer who knows what she is doing.

This is how it's supposed to be, this is how you save money, get a good service and put all the chances on your side. If the customer has no idea what he wants nor what to do, then yes the vet can SUGGEST alternatives, but if someone like you who's already testing and knows what she wants, approaches a vet, then he/she should respect your needs and situation.

I personally said farewell to my old vet cuz she was discouraging me from testing my cat... she said I would severely hurt her ears for no good reason. Then when I called different vets the first question was : "Ok I want to know if you are FOR or AGAINST home testing for a diabetic cat?" Without even giving them another information I requested that answer and would not go any further if I was not satisfied with the answer. And this is when you start noticing how vets can be either ignorant and/or cash addicts or experienced and/or willing to help.
dancing_cat

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

Then ask if they would be able to get some Lantus insulin for your cat and how much it would cost for a fructosamine test (that you could plan to do in about 14 days). They'll understand that they're about to deal with a determined customer who knows what she is doing.

Fructosamine tests are good for diagnosis purposes, but they're unnecessary if you're home testing. It gives you an average blood glucose level for the previous 2-3 weeks, which you can do yourself with your daily numbers and a spreadsheet. It's more important to see the highs and lows in a day than an average number over a period of weeks.

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

So I finally got a call back from the vet tech. I'm guessing she prescribed lantus or a generic verision, if there is one. Here's what I was told to get:

Insulin glarzine (yes a z as in zebra I had her spell it twice)
10 u per vial
 u100 syringe
1u twice a day 

Now if I'm not mistaken glargine is Lantus. She then said they'd do a curve after a week of this. But of course, when I get the insulin and head over for the injection tutorial I will suggest that I am capable of doing it at home.

I still want to switch vets. But what is more important to me in the immediate is getting my boy in safe numbers. If that means keeping this one until he's stable and then switching I can learn to grow a backbone - at least where this matter is concerned.

Edit: I just called into the pharmacy. They didn't get the script but a 10u vial of lasntus is $120usd. And at 2u a day that won't go a week!! Insert emotional wreck here.
Uh
Thoughts on dosage? I really hope this is an am pm thing because no one else who can do it will be home in the afternoon

 

[BJM]

Re: Confused About a Vet's Insulin Suggestion

Whoops - insulin math!
1 vial is 10 mL
1 mL is 100 units (hence the U-100 designation)
therefore, 1 vial is 10 * 100 = 1000 units
at 2 units per day, that is 500 days
at 4 units per day that is 250 days

Yup, its an am/pm thing, as close to 12 hours apart as you can make it.

Giving the injection isn't difficult as it is subcutaneous.
Its a 4 P process; basically, you gently
Pull up a fold of skin, usually wherever the skin is somewhat loose (back of neck or back, a smidgeon away from the scruff)
Press the needle through into the center of the tented area - it should have very little resistance as it has no muscle there.
Push the plunger in.
Pull the needle out.

To visualize it better, try pulling up a fold of the clothing you are wearing. Notice how there is an airspace created? That is similar to what happens if you pull up a fold of skin - an area with room to expand to contain the tiny amount of insulin you are inserting. You're aiming for that 'hollow' made by the tenting.

To help you track the numbers and observations, it will help to create a spreadsheet. Instructions are here

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

So I finally got a call back from the vet tech. I'm guessing she prescribed lantus or a generic verision, if there is one. Here's what I was told to get:

Insulin glarzine (yes a z as in zebra I had her spell it twice)
10 u per vial
 u100 syringe
1u twice a day 

Now if I'm not mistaken glargine is Lantus. She then said they'd do a curve after a week of this. But of course, when I get the insulin and head over for the injection tutorial I will suggest that I am capable of doing it at home.

I still want to switch vets. But what is more important to me in the immediate is getting my boy in safe numbers. If that means keeping this one until he's stable and then switching I can learn to grow a backbone - at least where this matter is concerned.

Edit: I just called into the pharmacy. They didn't get the script but a 10u vial of lasntus is $120usd. And at 2u a day that won't go a week!! Insert emotional wreck here.
Uh
Thoughts on dosage? I really hope this is an am pm thing because no one else who can do it will be home in the afternoon

There's no such insulin as glarzine. She definitely misspelled glargine, which is Lantus.

There is no such thing as a 10u vial. Lantus comes in 10 ml vials. Each ml contains 100u, so one $120 10ml vial of Lantus will contain 1000u.

However, I would ask the vet if you can get them to write a script for the PENS instead. You will never get through 1000u of insulin before it goes bad. The pens come in 5, 3ml (300u ea., for a total of 1500u) pens that you use as a mini-vial. You use syringes with them exactly the same as you would a vial. One pack will last you 6months-a year, and you will have hardly no waste, saving you a ton of money in the long run. The vial is only guaranteed to last 28 days, but with good handling you can sometimes stretch it out longer. My last vial, with good handling, only lasted 3 months.

If you print out this $25 off coupon out, the pack of pens should cost you about $219 at Walmart (I would call around--certain pharmacies are more expensive than others).

http://www.lantus.com/solostar-insulin-pen/solostar-coupon.aspx

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

Julia & Bandit - Do they have to write the prescription specifically for the pen version? I'm starting to get the feeling it's the vet tech herself that's getting annoyed at me (calling every day, sometimes calling her back when she hangs up because I still had a question.) If I were to speak with the pharmacy tech would they be able to arrange to get the pen prescription instead (by calling them back, etc.) =__= I think i'm hitting a failing point in my attempt to grow a backbone. I might just buy the vial for now and ask the VET specifically (who is always quite nice to me) to write a prescription for the pens next time.

Edit:
And hope that it's the tech who's getting all these things confused and not the Vet herself.

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

Julia & Bandit - Do they have to write the prescription specifically for the pen version? I'm starting to get the feeling it's the vet tech herself that's getting annoyed at me (calling every day, sometimes calling her back when she hangs up because I still had a question.) If I were to speak with the pharmacy tech would they be able to arrange to get the pen prescription instead (by calling them back, etc.) =__= I think i'm hitting a failing point in my attempt to grow a backbone. I might just buy the vial for now and ask the VET specifically (who is always quite nice to me) to write a prescription for the pens next time.

Edit:
And hope that it's the tech who's getting all these things confused and not the Vet herself.

It does have to say "glargine pens" in the script, I believe.

If you want to start with the vial and move to the pens, many people do that, so that's not a bad plan. In fact, that's what I did. In retrospect, I just wish I had known about the pens first because it would have saved me $120 in the long run. I think it's a very good idea to speak to the Vet instead. Usually the way this goes is that you go to the vet's office, they write you a script, hand it it to you, and then you take it to whatever pharmacy you choose to get it filled.

Is what happened in your case that the vet called in the prescription to a single pharmacy, and you have to go pick it up? Did you choose that pharmacy? The vet tech cannot write a prescription--only the vet can. It's the same as when you go to the doctor and have to get your prescription from the doctor, not the nurse.

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

@Julia & Bandit - The vet-tech requested a pharmacy of my choices' number to call in the prescription. The first time I called the pharmacy to confirm this happened they told me they had received no prescription. After talking to the vet-tech she got a bit snippy with me saying she had but requested the number anyway (the number she had was wrong, it turns out but she didn't want to acknowledge it.)

Lo and behold, an hour later and a prescription for Lantus for Shiro was waiting at the pharmacy. The only thing is, on Monday when I called I had specifically requested a pen (I remembered that now.) I let the pharmacist know this and he told me he would call back the vet and confirm that they would OK a pen script. He says the pen runs about $47 (single) and $230 for a 5 pack. How long is ONE pen good for at Shiro's currently prescribed rate: 1 unit twice a day. ...300u per pen would mean 150 days right?

I get to call the pharmacy back in an hour to see if the vet okay'd a pen version. I have no reason to believe they wouldn't...I hope.

---

Now that I know it's an AM PM thing (which I can manage alone at 12 hours apart - I can just take a quick break during longer work shifts) I wanted to know...how does his feeding schedule change?

He's at 4 cans of fancy feast classic, four times a day (although occasionally he eats half a can only and we give him the other half within the same hour.) I don't know how HE, or my parents would tolerate only two feedings a day, even if they were large helpings. I know the am and pm shots have to be done during eating or right after he eats (with testing before and after as well) and on 4 out of the 7 weekdays I will be able to test him at the six hour mark as well - but what about feeding in between? I'll ask the vet these questions as well but what has been your experience. I don't think you guys will blame me for wanting to get a second opinion on everything these days.

 

[BJM]

Re: Confused About a Vet's Insulin Suggestion

How long is ONE pen good for at Shiro's currently prescribed rate: 1 unit twice a day. ...300u per pen would mean 150 days right?

Exactly, if you are dosing 1 unit, twice a day (also called BID)

that I know it's an AM PM thing (which I can manage alone at 12 hours apart - I can just take a quick break during longer work shifts) I wanted to know...how does his feeding schedule change?

1) Its OK to put out the food 2 cans at a time and let him nibble throughout the cycle. You might freeze one can's worth so it is thawing and fresher towards the middle of the 12 hours. Alternatively, a timed feeder may be used. You want more of the food consumed during the first 6-8 hours, as the Lantus typically starts wearing off and the glucose starts rising after the nadir which usually falls around 6 hours post-insulin, give or take an hour or two.

2) Ideally, you test, feed, and if safe (at or above your no shoot number), give insulin. Initially, we recommend you not shoot below 200. As you collect data on how your cat responds, that no shoot number drops. Just starting out, pick a day when you'll be able to observe how he is responding and be able to test around 6 hours (+6) after the injection. To be cautious with the first dose or if you can't be there (or awake) to monitor, you might consider just 0.5 units to start.

You'll want to review How To Handle A Hypo and have the supplies needed in the event he goes too low.

And you'll want to go to one of the Lantus forums, read over the sticky posts on Lantus, and begin posting there, where you can get lots of feedback from experienced Lantus users.
Lantus Tight Regulation - a strict protocol with good results at getting cats well controlled and sometimes, off insulin and diet-controlled.
"Relaxed" Lantus - users here may not be following the tight regulation protocol for various reasons such as complex medical problems, idiosyncratic responses to insulin, and scheduling problems, among other reasons.

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

Okay! So, long story short the vet has gone home. But the vet tech (new one, new shift) fully expects the one pen to be approved. I can't start him tomorrow because I wont' be able to monitor him at the +6 point, so I'll start him on Friday - my day off. The vet whom I plan on switching his care to after he's regulated gave me a call back. She was a total sweetheart and seemed very well informed - even directing me to Janet and Binky's page, giving me off the record advice on lowering doses if needed and telling me to go ahead and call with any emergency questions, since she knows my current vet is so...impossible to get ahold of.

The only thing I didn't fully understand was that she suggested a 3/4 syringe. My vet asked me to get a u100 syringe but didn't specify the length (which I assume the 3/4 refers to D: i'm such a novice.) What should I ask for at the pharmacy? Is there a gauge...? I'm so lost!

 

[BJM]

Re: Confused About a Vet's Insulin Suggestion

Okay! So, long story short the vet has gone home. But the vet tech (new one, new shift) fully expects the one pen to be approved. I can't start him tomorrow because I wont' be able to monitor him at the +6 point, so I'll start him on Friday - my day off. The vet whom I plan on switching his care to after he's regulated gave me a call back. She was a total sweetheart and seemed very well informed - even directing me to Janet and Binky's page, giving me off the record advice on lowering doses if needed and telling me to go ahead and call with any emergency questions, since she knows my current vet is so...impossible to get ahold of.

The only thing I didn't fully understand was that she suggested a 3/4 syringe. My vet asked me to get a u100 syringe but didn't specify the length (which I assume the 3/4 refers to D: i'm such a novice.) What should I ask for at the pharmacy? Is there a gauge...? I'm so lost!

You want a U-100, 30 or 31 gauge, 5/8" needle, syringe with 1/2 unit marks. While there may be some child syringes out there, the preceeding is what those of us using a U-100 insulin (Lantus, Levemir) use. They do make them! Check the shopping link for the American Diabetes site if you don't find them easily or inexpensively at a local pharmacy.

 

[Julia & Bandit (GA)]

Re: Confused About a Vet's Insulin Suggestion

he told me he would call back the vet and confirm that they would OK a pen script. He says the pen runs about $47 (single) and $230 for a 5 pack.

This is fantastic! Most places won't sell single pens, so you are very lucky. Make sure you speak to the pharmacist about the number of refills you have available on your prescription, because if you're buying them singly then you'll probably need them refilled frequently (likely each pen will last between 2 and 4 months, depending on how it's handled). Of course, it also depends on how much insulin you go through. 1u is the starting dose, but you may need to raise it higher than that. Bandit never needed more than 1u twice a day, but my friend's diabetic cat that I'm helping out has at times needed doses as high as 2.25u. He's at .25u now, though.

 

[AvalonWitch]

Re: Confused About a Vet's Insulin Suggestion

cat(2)_steam The veterinarian rejected the request for a Lantus pen, single, five pack, anything but a vial. I asked of the vet tech (who was the third i'd spoken to and the 2nd time for that day in particular.)

"But why? It's the same medicine in a different packaging."
"Dr. ---- Doesn't feel it will work as well and doesn't feel comfortable filling a pen. If you like you can come in for a more detailed explanation."
"No thank you. I think we'll be looking for someone else now because that's just...i'm sorry. No."
"Oh well i'm sorry to hear that. Goodbye."

I'm working on making an appointment with the vet i've been emailing/talking to. My dad isn't handling this new frustration all too well. I told him this happened. He demanded a certain time and date (Saturday at 8) with the new vet and unfortunately she's off that weekend. Then he started making all these random accusations about my therapy schedule and...=__= bah. That's another matter.

I think I'll just end up taking Shiro to the new vet myself in a taxi on Thursday (when I get out early from school) or Friday. =__= Once again it's me vs. my parents. And we were doing so well too.

Edit 8D before I even posted
Dad walked in much calmer and said to ask for 5:30 Friday. It was open. Looks like Shiro's starting insulin either Saturday or Sunday!

So the big question is...why would they say no to a pen? The receptionist at the new vet seemed surprised but suggested that it might not work as well and maybe that was why?...but I've been under the impression it's the same medication. So...what's up? Is there any literature that might convince the new vet otherwise (she seems much more reasonable). Please do let me know if this belongs in one of the two Lantus threads.

 

[MommaOfMuse]

it is exactly the same insulin just in a different container. Unless they aren't aware that you can use a syringe to draw it out of the pen and are thinking that Shiro may at some point need less than full units. Otherwise I have no clue why they would deny the pens over the vial.

I know my vet was surprised that I used a syringe to draw Musette's Levemir even though he agreed with me that it was an excellent insulin for cats, he was just unaware that you could use a pen for a cat because of the fact that normally they take smaller doses that the pen alone would normally allow.

Mel, Maxwell, Musette & The Fur Gang

 

[Ry & Scooter]

What a fiasco. So glad we don't need prescriptions for insulin in Canada @-) I had the luxury of just walking into the pharmacy, asking for the 5 pack of Lantus pens, being handed them no questions asked, paying, and walking out. Oh and Lantus is less than half the price here... I paid $105 for the 5 pack. I don't know if you can buy it from Canada though... might be worth looking into in the future if you need. It still lasts a very long time though.

 

[Melanie and Smokey]

How long is ONE pen good for at Shiro's currently prescribed rate: 1 unit twice a day. ...300u per pen would mean 150 days right?

If the insulin stays good that long. They are only stated to last 28 days, most people get longer but I don't know about 150 days. I've gotten 3 months on a vial, but never much more than a month on a pen myself.

So the big question is...why would they say no to a pen?

The other vet at my vet's office said that the research they see says the pens are problems and should not be used. Now I don't know if that is just because of the tips that come with them and the information was not in regards to the pens being use with syringes and drawn just like a vial. But if my vets are seeing information like that, your vet may well be seeing that too. It was a mute point for us because we were switching back to a vial at that point anyway. The pens were not lasting long enough to make it cost effective for us to use them .

I know getting the pens is really stressed on the board here. But it is the same insulin and if getting the vial makes things less stressful, I'd just get the vial. IMO its more important to get your cat on insulin than worry about the packaging it comes in.

 

[AvalonWitch]

@Melanie and Smokey - I have to admit the increased longevity of the pen (according to quite a few people) is a factor in preferring them. Though I understand ECID. With that said, i've not seen any research showing problems with the pens- it's the same insulin after all. And the only (very good) issue with them I've heard is about three dosage increment limitations when not using a syringe to draw. However I would be using a syringe.

However the delicacy of the vial puts me off. As do the quantities inside them. Also even if they both only go a month...the vial is 120 and the pen is 47. The fact of the matter is: if it comes down to vial or nothing it will probably end up being nothing, a decision that is my father's, not mine, but that I have no choice over it. There is no way he'll accept a 120 a month expense.

 

[Pumbaa]

Avalon: I am so sorry to read what you are having to deal with, with the vet and your folks, when all you want to do is take care of your kitty, which is stressful enough all on its own. Here's a :YMHUG: for you...just because.

The new vet sounds wonderful. If I were you, I would switch vets immediately. But that's me.

Make sure you print out this $25 coupon for Lantus Solostar pens. Before you have the prescription filled, call the pharmacy first and make sure they will honor the coupon. BTW, the pens are a higher initial expense because you have to purchase a 5-pack, but they are more economical overall as, if they go bad, you are only tossing the balance of 3 ml, instead of the rest of the 10 ml vial. And do check the expiration date at the pharmacy. I went to Costco today, used the $25 coupon, got the 5-pack of the pens which don't expire until 7/2014, for $200. Hope that helps.

 

[Melanie and Smokey]

With that said, i've not seen any research showing problems with the pens- it's the same insulin after all. And the only (very good) issue with them I've heard is about three dosage increment limitations when not using a syringe to draw. However I would be using a syringe.

I did not see the research myself either - it is in their veterinary research, stuff I don't have general access to. As I said I was going back to the vial so I did not ask about it farther.

However the delicacy of the vial puts me off. As do the quantities inside them. Also even if they both only go a month...the vial is 120 and the pen is 47. The fact of the matter is: if it comes down to vial or nothing it will probably end up being nothing, a decision that is my father's, not mine, but that I have no choice over it. There is no way he'll accept a 120 a month expense.

I actually disagree with the idea that the vial is that delicate. Our vials have held up much better than the pens. That was one of the deciding factor in going back to the vial, the insulin in the pens was pooping out quickly, 3X faster than the vial did to us. Just wanted to point out what we've experienced as actual users of the vial. Even handing our first vial poorly we got 3 months out of it, not 1 month.

if it comes down to vial or nothing it will probably end up being nothing

,

I hope not since it would leave you kitty to get sicker and sicker and the decision would be based on bad information since a vial should easily make it past 1 month of use as long as it is kept in the fridge. Hopefully you can get a pen, but if not I hope you do consider other treatment options.

 

[Julia & Bandit (GA)]

If the new vet won't give you the script for the pens, please just get the vial. Some vets don't realize you don't need to use the needles that come with them (you use a syringe instead), which is why they don't prescribe them. My vet had never heard of using the pens, and was against it until I explained and showed her the video of how you extract the insulin with a syringe just the like a vial, and then she was all for them.

But please don't let the pen vs. vial debacle get in the way of treatment! I suggested the pens because money seemed a big concern for you, but vials can last months at a time if handled carefully, and yes the pens are less expensive over the long run, but the truth is you have no idea how long your cat is going is going to need insulin (the sooner you start, the better are his chances of getting off it).

 

[AvalonWitch]

Melanie & Smokey and Julia & Bandit - I appreciate and fully understand your concerns. If it were up to me alone, of course the vial and pen debacle would not be a make or break issue in this matter. However the fact remains that Shiro is not mine, he is my father's. As far as my father is concerned, any money I pay for his care is his because I earned it working for his company. Why do I have to pay? Because I started "this mess" by bringing in my own cat, Merlin. And our special needs cat Puss. Although Shiro is my parent's (primarily father's) cat - the responsibility for his financial and medical matters falls onto me. That's fine. Even if Shiro was the meanest cat on the planet - I would still love him.

In the end, the decisions are his to make and mine to try to guide. He has all but made up his mind that he is only willing to pay for the pens and will not fund a vial. Nor would he allow me to keep using a vial past the 28 day expiration date - it's one of his "things." A $120 a month vial expense compared to a $47 a month pen expense to him seems make or break - and while I can try to gently talk to him about it all I can, the fact remains that if I push him too hard I am not only risking the Cat's life (by pushing him to decide that it's "easier" to put him down) or my own (by risking getting kicked out of my family home, with no way to get a job, rent a home, or continue school.) I understand how difficult it may be to understand the type of situation i'm dealing with, but sadly logic and reason play almost no role in their decision making and I am more or less bound to their whims (whatever they may be at the time and however frequently they may change.) There are no testimonials, research papers, calm conversations that will change my parent's mind when they've made up to do something unless they themselves want to change their mind. And I do not believe his mind will change on this matter. I can only hope that people will understand that I'm just as horrified with these ultimatums as I am - but they are what I have to work with.

Luckily! My new vet replied to my inquiry regarading the lantus pen essentially saying she had never heard of it; but that if it was the same insulin she would be willing to do research and learn how to use it together. Shiro's appt with her is this Friday at 5:30. I'll be posting this request in the Lantus forum (because I think that would be a good place to gather this type of info) but i'd like to be able to bring in information and print out a tutorial or two on how to use the lantus pen with a syringe. Since we're both new to this I think we'd both do better with experiences and scientific data regarding using it (the pen) with a syringe.

 

[Terwilliger1]

I was able to get a single Lantus pen from my Illinois CVS pharmacy for $25 after I requested the vet to call it in. I'm picking up a re-fill today so we'll see if the price is the same. If you are able to get the pen, make sure you still get the U100 syringes if you haven't already. I think pharmacies get confused about the use for cats and try to get you to get a script for the little needles that are used with the pen. That's just my experience. Best of luck to you!

 

[AvalonWitch]

@ Terwilliger1 - It seems like we're some of the lucky ones! My walmart sells the single pen as well, for $47 I'll make sure to write that down on my list of notes to bring in tomorrow!