? Spot went to new vet, new insulin??

Darnell & Sprocket (GA)

Darnell & Sprocket (GA)

Member Since 2015
Hi. Spot went to the vet today to a new vet that is an endocrinologist.
Spot is 13 lbs & has maintained weight since being diagnosed in June. His food is pate of friskies, fancy feast or Special kitty or 9lives. He eats about 8-9oz a day broken up in multiple meals, about 4 a day.
Annette was following slgs until he hit 5 units then went to TR because insulin resistance is suspected. Every increase it appears it doesn’t seem to effect his bg. He has barely hit mid yellows.
Vet thinks his ideal dose yet also thinks a dose should be held for longer than 7 days. He wants her to feed 2x a day & start again at a low dose. Its been suggested she changes insulin. Maybe Lantus is not right for Spot. Levimer will be discontinued by end of year so would it be beneficial to try it now then have to change again later?
or should she try prozinc??

Spot had two bad teeth but not infected & he wasnt too worried. They did a urinalysis since he has never had one. Results will come later as a Culture & Sensitivity was done.

He says he is willing to do the acro/IAA but gives her an estimate of about $300 without even checking the prices. They changed her about $330 today already. They may not be able to do that right away.

https://docs.google.com/spreadsheets/d/1SF96F9mHVKPW1YyyLa0PcMDU8rbxxDLtMRfy_IGVmBc/edit?usp=sharing

will tag those that have discussed his progress in past. Others feel free to discuss too.
what should she do?

@Chris & China (GA) , @Wendy&Neko
@Bron and Sheba (GA)
 
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I agree that it may be time for something different. Since Levemir is being D/C'd, that leaves ProZinc and I'd give that a try before trying any of the other insulin's available. It works in a different way than Lantus and may be a better choice for Spot.
 
I would not go to Prozinc. He doesn't need a change in insulin, he needs a higher dose and when she can, those acro and IAA tests. Which might indicate a treatment that can deal with the resistance. We have several people with high dose cats go from Prozinc to one of Lantus or Levemir, but no one goes back once they've switched. Prozinc can also sting at higher doses and doesn't have as great duration. She could try Levemir now and stock pile vials before they stop being sold. Levemir typically has better duration than Lantus in higher doses, and definitely better than Prozinc.

That endocrinologist needs to turn in his badge. :rolleyes: Two meals a day is very old school. When resistance is present, holding a dose longer than you need to can make the resistance even worse. Dealing with bad teeth can also make a difference. You can't just eyeball the teeth and say they are OK. Neko's dental vet found something under the gum lines on x-ray, twice, that even his experience (he also teaches dental at vet school) did not find by just "looking at it". Sandy's Black Kitty was the first IAA cat diagnosed here, once he got his teeth taken care of, he did the fast and furious road down to OTJ. However Sandy had to deal with DKA twice, a scary ride.

Starting again at a low dose is a HUGE mistake. She started low and increased safely, by small increases and after waiting a week until 5.5 units. She does a great job testing. She did not miss any hidden lows. Therefore, Spot needs more insulin. Starting low, with bad teeth, could very well lead to ketones and DKA. And waste a lot of time. He needs more insulin not less.

I wish I could say we don't see this reaction from vets often. :blackeye:
 
Wendy&Neko said:
Levemir typically has better duration than Lantus in higher doses, and definitely better than Prozinc.
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The problem is Levemir isn't going to be available in the US. They expect to start to see shortages of it in Jan, 2024
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I usually would never suggest going to Prozinc from Lantus, but the other choice would be to try something like Treshiba.

But I do see your point too. She could just continue increasing until she (hopefully) hits a breakthrough dose.
 

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Darnell & Sprocket (GA) said:
But doesn’t that Treshiba require a vet to closely monitor?
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Not that I know of. It comes in a U100 strength and U200 strength so you'd want the U100. There's a forum for Treshiba here too.

I think Wendy makes a good point though. Annette could continue to increase until she (hopefully) hits a breakthrough dose. Need to concentrate on getting the Acro/Iaa tests done.
 
Annette cant afford the tests now. Lantus is expensive, how are the prices with levimer & prozinc?
If she changed she needs to get script tomorrow because vet is on vacation next week & she doesnt have enough insulin to last till he comes back.
 
Wendy&Neko said:
would not go to Prozinc. He doesn't need a change in insulin, he needs a higher dose and when she can, those acro and IAA tests. Which might indicate a treatment that can deal with the resistance. We have several people with high dose cats go from Prozinc to one of Lantus or Levemir, but no one goes back once they've switched. Prozinc can also sting at higher doses and doesn't have as great duration. She could try Levemir now and stock pile vials before they stop being sold. Levemir typically has better duration than Lantus in higher doses, and definitely better than Prozinc.
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I agree with this 100 percent. I’m so sad to look at Sprocket’s spreadsheet and see such familiar frustrating numbers. I am sorry. I got better results after switching to Lantus and even better results after switching to Levemir. The real key was following the dosing protocols here - especially for high dose kitties. My boy was VERY insulin resistant and needed a very high dose- at least until we could start Cabergoline after he was diagnosed as an Acromegaly cat. I would get the testing done as soon as you can. Waiting wastes valuable time where you could decide on some some treatment options.
 
Suzanne & Darcy said:
I agree with this 100 percent. I’m so sad to look at Sprocket’s spreadsheet and see such familiar frustrating numbers. I am sorry. I got better results after switching to Lantus and even better results after switching to Levemir. The real key was following the dosing protocols here - especially for high dose kitties. My boy was VERY insulin resistant and needed a very high dose- at least until we could start Cabergoline after he was diagnosed as an Acromegaly cat. I would get the testing done as soon as you can. Waiting wastes valuable time where you could decide on some some treatment options.
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Did you look at Sprockets spreadsheet or Spots? I am posting for Annette as she doesn’t know computers that well. Her spreadsheet is in the first post in thread.
Or did you just get the name wrong?
 
Ditto what Wendy and Suzanne said.

I used Prozinc in an acro cat and much prefer Lantus or Lev. I think going to Prozinc might be a step backward; restarting at a low dose would be, I fear, a huge mistake.

Sometimes vets get hung up on dose, especially high doses. A cat needs however much insulin it needs, period. I can’t count the number of times I’ve heard “the insulin must not be working and you need to switch” simply because a cat is a “big gulper.”

I too would get the acro/IAA testing done as soon as feasible. Knowledge is power, and just knowing why a higher dose is needed can be a relief, allowing you to settle into and accept that a larger dose might be normal for the situation. It also empowers one to consider next steps and be proactive in making decisions.

Just my two cents.
 
Darnell & Sprocket (GA) said:
Annette cant afford the tests now. Lantus is expensive, how are the prices with levimer & prozinc?
If she changed she needs to get script tomorrow because vet is on vacation next week & she doesnt have enough insulin to last till he comes back.
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Lantus is expensive but its generic, glargine, isn't nearly as much. Many people on this forum use glargine the generic. It's just a good as the brand name stuff. I don't have an exact price, but maybe someone else does. It's fairly inexpensive though.
 
JL and Chip said:
I too would get the acro/IAA testing done as soon as feasible. Knowledge is power, and just knowing why a higher dose is needed can be a relief, allowing you to settle into and accept that a larger dose might be normal for the situation. It also empowers one to consider next steps and be proactive in making decisions.
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yes we agree. She cant afford the test after today. Hopefully next month &
She is thinking she may call around again to find a vet that is more up to date on their knowledge. He said alot of negative things like he is just a cat.
She is pissed at his comments & I dont blame her.


Thanks for your input too.
Will update what she decides to do here.
 
Darnell & Sprocket (GA) said:
yes we agree. She cant afford the test after today. Hopefully next month &
She is thinking she may call around again to find a vet that is more up to date on their knowledge. He said alot of negative things like he is just a cat.
She is pissed at his comments & I dont blame her.


Thanks for your input too.
Will update what she decides to do here.
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??!!!??? The new vet said "he is just a cat." Seriously?? What an awful thing to say to someone. I'm sorry she had to go through that!!! I'd definitely look for a new vet.

On another note, I think some people use Good RX coupons for the glargine to get it for cheaper, if that could help.
 
Yes, Levemir vials will be available for a year, though I expect hard to get. But the point I was trying to make is that it isn't the insulin that's the problem, it's the dose. And Spot isn't at high enough dose yet. Going to Prozinc will not help that, and starting over at a low dose will make it even worse.

There are cheaper ways to get Lantus, here is one post about it:
Switching to Lantus (Glargine) Good RX $35
On Chewy is $120 for a 10 ml vial. It says the vial is good for 60 days. A lot of people were getting the Lantus brand, or Basaglar (a generic) from Marks Marine in Canada, for considerable savings.

Darnell & Sprocket (GA) said:
Or did you just get the name wrong?
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I suspect that is it, Sprocket's spreadsheet did not look insulin resistant.

Darnell & Sprocket (GA) said:
He said alot of negative things like he is just a cat.
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What!!!!! Ditch that vet.:mad: Whether the vet is up to date with knowledge, being willing to learn is also good. My vet started us on old insulin (Caninsulin) and I had to practically arm twist her to get the tests done (she thought you needed to get to 10 units, which Neko never did), but after the results came back, she was definitely on board with treatment. And recognized she had another acro in her practice. I had been going to her for over 20 years so had a good relationship.
 
Wendy&Neko said:
Yes, Levemir vials will be available for a year, though I expect hard to get. But the point I was trying to make is that it isn't the insulin that's the problem, it's the dose. And Spot isn't at high enough dose yet. Going to Prozinc will not help that, and starting over at a low dose will make it even worse.

There are cheaper ways to get Lantus, here is one post about it:
Switching to Lantus (Glargine) Good RX $35
On Chewy is $120 for a 10 ml vial. It says the vial is good for 60 days. A lot of people were getting the Lantus brand, or Basaglar (a generic) from Marks Marine in Canada, for considerable savings.


I suspect that is it, Sprocket's spreadsheet did not look insulin resistant.


What!!!!! Ditch that vet.:mad: Whether the vet is up to date with knowledge, being willing to learn is also good. My vet started us on old insulin (Caninsulin) and I had to practically arm twist her to get the tests done (she thought you needed to get to 10 units, which Neko never did), but after the results came back, she was definitely on board with treatment. And recognized she had another acro in her practice. I had been going to her for over 20 years so had a good relationship.
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I was thinking that the insulin wasn’t the issue either. The possibility is small.
He made it to yellow before his appointment today too.:D

and about my reply for her commenting about Sprockets spreadsheet. Ya…me duh. :smuggrin: Lol. I wasn’t thinking of that, my brain is tired, I went to vet too
Right after her & I was still texting with her there too. Its been a long day.

Ya she just told me all the negative things & I told her she might have to travel further to find a better updated vet. All the vets are in big cities in North Carolina & she lives in middle of nowhere in between the big cities but its long drives to each big city.

For tonight, she is going to call vet in AM & see if he will give a script for levimer before he goes for vacation then she can call around to get prices to decide if she should change.
That way she will have both scripts to fill one of
Them & will call around next week to find new vet too.

Then she can look at all the comments & decide what is best idea.
Thanks alot.
 
I don't know how far she is from North Carolina State University, but their veterinary teaching school is very knowledgable. One of our members just went there and said they have a cats only section in internal medicine, include steps up the wall for a cat to climb. :cool:

Chris & China (GA) said:
I would have loved to be there to watch you! Heck, sell tickets!...LOL
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Not literally arm twisting, she's about 6 ft tall! But I got to practice my negotiation skills. I believe the words "humour me" were used a lot.
 
Wendy&Neko said:
I don't know how far she is from North Carolina State University, but their veterinary teaching school is very knowledgable. One of our members just went there and said they have a cats only section in internal medicine, include steps up the wall for a cat to climb. :cool:


Not literally arm twisting, she's about 6 ft tall! But I got to practice my negotiation skills. I believe the words "humour me" were used a lot.
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Unfortunately one & half hours to get there for her & she said they are too expensive.

Maybe we can ask of they can recommend a vet that is closer to her yet knowledgeable & less expensive.


I have heard the “humor me” alot too. Lol.
Love my vet now! Took me 5 vets to find her but so happy now.
 
Darnell & Sprocket (GA) said:
yes we agree. She cant afford the test after today. Hopefully next month &
She is thinking she may call around again to find a vet that is more up to date on their knowledge. He said alot of negative things like he is just a cat.
She is pissed at his comments & I dont blame her.


Thanks for your input too.
Will update what she decides to do here.
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Just a cat!!!! I might have said … “and you’re JUST a vet!”
 
Staci & Ivy said:
I paid $35 for a box of Lantus pens (could have gotten vial also) at a local CVS. The script had to be worded specifically (see attachments) and I brought the Sanofi coupon generated on their website. Hope this helps.
View attachment 68437View attachment 68436
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This does help... should be a sticky that gets bumped multiple times a day. Everyone needs to know this!!! The less we spend on insulin, the more we can spend on higher quality foods or other medications our cats need. Stretch the budget.

To have 5 pens in the fridge that don't expire for a year or more is a no brainer for $35.
 
Jason - Kona's Dad said:
This does help... should be a sticky that gets bumped multiple times a day. Everyone needs to know this!!! The less we spend on insulin, the more we can spend on higher quality foods or other medications our cats need. Stretch the budget.

To have 5 pens in the fridge that don't expire for a year or more is a no brainer for $35.
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I agree. My mind was blown after I spent $300 in a pinch for my first vial of Lantus. And I thought, hope that hell am I gonna afford this insanity???
I wish everyone knew this little gem!! I try to share any time I can! :bighug::bighug:
 
Suzanne & Darcy said:
@Max & Lori you are in NC. Any help with a good vet?
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NCSU is an hour away from me as well, but they are excellent there so the travel isn’t a big deal for me. My regular vet is in Wilson, NC and I went through 3 vets before her because when Max was diagnosed, I needed someone who was open to working with me in caring for him. I haven’t had any problems with my regular vet, but because Max has so many problems, I also use NCSU internal med, especially now. Not sure if Wilson is near you or not?
 
Max & Lori said:
NCSU is an hour away from me as well, but they are excellent there so the travel isn’t a big deal for me. My regular vet is in Wilson, NC and I went through 3 vets before her because when Max was diagnosed, I needed someone who was open to working with me in caring for him. I haven’t had any problems with my regular vet, but because Max has so many problems, I also use NCSU internal med, especially now. Not sure if Wilson is near you or not?
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Annette is in Ellerbe, NC.
Opposite direction. The vet she went to yesterday was in Laurinburg
 
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