Starting Insulin Uninformed Questions

Status
Not open for further replies.
AliciaG

AliciaG

Member Since 2015
I want to start Juliet on insulin so I called the vet to kind of get a "So I think I'm ready, now what?" The vet techs are very nice and she gave me a nice BIG ball park of the initial costs.

My questions is, when beginning stabilization, is this completely done from the clinic? The tech mentioned that the curve had to be done themselves in the clinic, but I had thought the doctor said I could do it from home...But that's to initially get her stable so then I do my own from home after?

Another thing was the insulin, I was told that it had to be paid for up front as it's something they had to order, (up to $500.00 depending on what the doctor want to give her) but does it have to be from the clinic? I've heard various things about being able to get a prescription and then picking it up at a pharmacy...

I'm giving the vet another go, I just feel that while they will give the best treatment, its going to be the most costly despite my mentioning that we are looking for ways to keep the costs down. It's just super depressing really. :(Hopefully I can get over to speak with them tomorrow or Friday. Meanwhile, I'm keeping my ear out for new vet suggestions. I like how close the current one is but I feel that they are going to treat things the way they want to, and I don't really feel like he listens very well.

Can someone please walk/talk me through the beginning of treatment. Ex- clinic where they this, then you'd do that etc? It would be truly helpful.
 
Hi, Alicia - No, this does not need to be done in-clinic by the vet. As for cost of insulin, depends on which one you choose, and you do not have to get that in your vet's office, either. Has Juliet ever been on any insulin before this? As I would encourage you to consider either Lantus (if a first time use of any insulin ever) or ProZinc.

Are you able to test blood glucose at home throughout the cycle? You always need to get the am/ pm pre-shot #s (AMPS/PMPS) to keep your cat safe.

Is excellent that you've changed diet; as you've already seen, this can bring BG #s down considerably. Can you tell me what you are feeding Juliet right now, and how much? How much does she weigh? And is she underweight at this time, or overweight?
 
If you don't feel that this vet listens all that well, please find a vet who does - and one who would encourage you to do home BG monitoring.
(You'd be surprised at the # of vets who are not very well-versed on effectively treating diabetes!)

Btw, I don't know where you live in Colorado - but I am on the western slope part of the year, and even in the more rural areas, there really are some vets around who will be amenable to you doing your own BG monitoring (most here use human-type glucometers, which are less expensive in terms of test strips). Another important point about in-clinic testing: Cats usually stress out at a vet's office, which can spike their BG #s, as compared to being tested at home where they are more relaxed!
 
She has never been on any insulin this is our first time with diabetes, we've already bought a glucose monitor and have actually been recording the results ourselves, so that hurdle will be fine. Right now I feed fancy feast classic under 8%. She doesn't like the beef. :p Everyone (I have 4 all together) receives a single serving (can) twice a day, morning and evening. Juliet is currently 13lbs and has the grumpy momma attitude to match.:) She has been surprisingly patient with the ear pricking but don't mess up because it only lasts so long. lol
 
You can get a scrip for insulin from the vet and order it online for MUCH cheaper. Do not pay the vet price for insulin because they way over charge!!

Find out which insulin they want you to use (either Prozinc or Lantus. If they offer the choice of using Vetsulin, don't go for it. It's cheaper but much harsher on the cat and harder for you to get her regulated. The others are more expensive but way better in the long run).

If the vet picks Prozinc: order it at ValleyVet.com. It's $95 for a vial that will last around 3-4 months. The vet will need to call or fax in the scrip and they will overnight the insulin to you (shipping is free). You can order the U40 syringes for Prozinc at ADWdiabetes.com. I forget how much they are but that was the cheapest place I found them.

If the vet picks Lantus, you can order it from a Canadian pharmacy. @pevsfreedom just got some for $150. Yes the Lantus is more expensive at the outset but the unit sizes and syringes for it are different, you'll need U100 syringes. The units on a U40 syringe don't match the units on a U100 syringe. A friend of mine gives 4 units of Lantus daily and her vial lasts nearly 5 months. Seems like the Walmart U100 syringes are cheapest. (You can even use the U100 syringes with Prozinc if these syringes are cheaper but you would have to use a conversion chart to make sure you're giving the correct dose. There's a conversion chart on a FDMB if you need one of us to post the link.)

You can do your own curve at home. It's more likely to be accurate because Juliet won't be stressed out so her BG won't be artificially inflated like it would be at the vet. DON'T let them guilt you into going into the office for a curve. And don't let them try run a fructosamine test. That's a waste of money if you're testing at home.

I learned how to test BG and shoot insulin by watching videos on YouTube, the vet doesn't need to show you that either.

This is getting long so I'll post my story in the next post. :)
 
Please don't ever pay $500 for insulin. Lantus should be no more than $300 delivered if ordered from US, and I order from Canada even cheaper (around $150 but a little tougher to find). VetRXDirect in the USA does Lantus for $277 a vial or $93 a pen I believe, and 77canadapharmacy.net is even cheaper still, though a bit more work.

You can do the curve and all home testing with something like this, and strips for $25 for 50. A curve takes maybe 6 strips - something the vet would charge well over $100 for.

http://www.amazon.com/Diabetes-Testing-Contour-Active1st-Solution/dp/B00NG0MSPQ/ref=sr_1_3?ie=UTF8&qid=1439240678&sr=8-3&keywords=bayer contour next

You can manage most facets of diabetes from home, all you really need a vet for unless there is complications is for the prescriptions and perhaps testing.
 
My old (bad) vet was very hands off. I got a call that Marshmallow's blood work came back positive for diabetes. I went in and picked up a scrip. I did research on where to order for the best price and found ValleyVet.com since the vet said to use Prozinc. Turns out I didn't even need to pick up the scrip since the vet had to fax it directly to ValleyVet.com themselves.

The vet said to bring her in to learn how to shoot. I watched YouTube and figured it out myself. This might not be comfortable for you but I used to have to inject my own meds into myself so I wasn't squeamish about it. There are others here who can post suggestions for how to practice before actually shooting the cat. I think testing BG is harder than shooting insulin, and you've already got the hard part down!

I went in to the vet for a curve two weeks after starting insulin, but this wasn't good vet advice. You can do a curve at home earlier in the process to figure out her dosing. My vet started Marsh on 2 units, which was too high.

Once you've identified which insulin to use, go to the forum specifically for that insulin and ask about appropriate doses to start out with. There is a wealth of knowledge on this board!

When I first started treating Marshmallow, I hadn't found this board yet and I totally felt like I was on my own. You've already found us (yay!) so take advantage of us :) and post all of your questions.

Your vet is a good place to take Juliet when she's sick, but when it comes to the day-to-day treatment, doing it at home is best (and cheaper!).
 
AliciaG said:
She has never been on any insulin this is our first time with diabetes, we've already bought a glucose monitor and have actually been recording the results ourselves, so that hurdle will be fine. Right now I feed fancy feast classic under 8%. She doesn't like the beef. :p Everyone (I have 4 all together) receives a single serving (can) twice a day, morning and evening. Juliet is currently 13lbs and has the grumpy momma attitude to match.:) She has been surprisingly patient with the ear pricking but don't mess up because it only lasts so long. lol
Click to expand...
That's GREAT that you're testing regularly. Would be good for you to get a spreadsheet started here (you can see an example if you click the link in my signature). Here's a link to the instructions:
Sticky 12/27/14 How to Create a SS and Link it in your Signature

Is also great that you're feeding the FF Classic formulas that are less than 8% carbs - which flavors are you using? As some of the Classic pates are higher in carbs than others; if, say, your kitty is extra carb-sensitive, is smart to stick to the ones that are 4% carbs or less. I only mention this because you've already seen Juliet's #s drop into the 200s with a change in diet. And in some cats, a % shift down to just a carb or two less, can often drop BG #s even further! (Found that out with my own cat by trial & error.)

Also, here is a body condition chart to help you assess Juliet's optimum weight: body condition chart
 
I'm sure all of this is overwhelming so I'll end by saying you clearly love Juliet and are trying to do the right thing by her. And I'm not dissing your vet in particular, it just seems like most vets are taught a specific way to handle diabetes and it's kind of old-school and not as hands on as we are here. Good luck and let us know how it goes!
 
I found shooting insulin to be pretty easy. Checking blood took a few days to get comfortable with and I refused to do it at first, but the green #'s I've been getting lately don't lie!

A curve once you've been home testing for a bit is nothing. I do curves sometimes without even thinking about it. No need to ever pay the vet that much $. Same goes for fructosamine checks for the most part.

Getting an Rx at the vet for insulin and taking it to a pharmacy is just like anything else. You get the script, go to the pharmacy, place your order. Vet shouldn't have to special order anything, and you can go through any online vet pharmacy who will just fax the approval to your vet without any work on your behalf really - and you'll get the insulin way cheaper than what the vet wants.
 
Before I forget, just so you're aware: My cat is tested with a (pet-specific) Alpha Trak meter, so the BG #s are 30%-40% higher than on human glucometers. Alpha Trak is really no better than a human meter - just more expensive in terms of the darned strips! (Which is why most here don't get talked into using one, as I had been by my vet ...)
 
@pevsfreedom - I hear you; had I been involved with FDMB at the time of 1st dx in 2013 (gah, was I in a panic!), I doubt I would have gone with an Alpha Trak. But being a creature of habit, just stuck with it...:rolleyes: (If Bat-Bat suddenly needed to be tested a lot more frequently for any length of time, I would seriously consider switching to a human meter in future.)
 
I won't lie it's kind of funny you know it's extra $ but you stuck with it! I'm the opposite, if I can save 1 $ I'd drop my meters and grab something else! :)
 
pevsfreedom said:
I won't lie it's kind of funny you know it's extra $ but you stuck with it! I'm the opposite, if I can save 1 $ I'd drop my meters and grab something else! :)
Click to expand...
@pevsfreedom Both vets (2 states) use Alpha Trak meters - I just figured it's been worth it to keep them from getting confused ... (not to mention that I have a lot of trouble with # translations myself:confused:). On balance, I've saved plenty - just by not plunking down the big bucks for in-clinic fructosamine tests!
 
Alicia - Please let us know if you have any trouble with getting a spreadsheet up & running. As there are members here who are really great at helping you with that. (Unfortunately, I'm not one of them; I needed a lot of help with that myself!:rolleyes:)
 
You guys are the best!!! I am literally in tears here. I am definitely going to go "vet shopping" today and make phone calls. Or just duke it out with the current one...hmmm still going to get referrals. Thank you thank you thank you thank you!
 
@AliciaG I saw your post in the other thread (Advice My Vet Gave Me) and I agree with Robin&BB and you about looking for a new vet especially after the comments your vet made. I question how ethical and good a vet is who has determined a cat with neuropathy has a blood clot and should be put down merely because your cat has diabetes.

A lot of good advice is given here. You're under no obligation to buy anything from the vet and yes, you can do the glucose checks and curves at home. As for insulins, you can also check the For Sale section of the Forum; members often sell insulin at a good prices.

Glad you're ditching the needless expensive prescription food. You want to aim for canned/wet low carbs under 10%. Here's a handy food chart: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

If you do decide to go with ProZinc, I'll find the handy conversion chart. I suggest reading the "stickies" in the Lantus and Prozinc forums to give you an idea of how each insulin works first.
 
@AliciaG - The above is just the sort of thing that we do while waiting for the latest on your Juliet. ("But, soft! What light through yonder window breaks? It is the east, and Juliet is the sun." Now I'll have the Bard's work stuck in my head all day...:rolleyes:)
Anyway, Alicia - How goes it for you & your kitty today?:)
 
It may drive you crazy to know that all of our kitties are named from Shakespeare plays. :) there is also a Claudio from "Much Ado," Sebastian from "Twelfth Night" and Iago from "Othello." I did argue about the last one because I didn't want to raise an "evil" kitty. The only terrorizing he does though is to Sebastian. Follows him everywhere!

Juliet worries me. She's been hiding or in the carrier mostly when she had been doing better earlier and her walking is worse. I know the zobaline is really just a bandaid over a bleeding jugular but I feel that I'm doing something at least. The original vet has to research?- this is exactly what the tech said- hasnt gotten back too us and the other vet we think we'd like to work with can't see us until next Saturday but we are on the list in case anyone cancels before then. So waiting and researching and hoping right now. Have I mentioned you guys are really awesome? This is the most Ive interacted with anybody outside of home and work. Im a workaholic and a little bit of an obsessive compulsive cleaner. Can't stand a dirty kitchen or clutter. I shudder at the thought.
 
AliciaG said:
It may drive you crazy to know that all of our kitties are named from Shakespeare plays. :) there is also a Claudio from "Much Ado," Sebastian from "Twelfth Night" and Iago from "Othello." I did argue about the last one because I didn't want to raise an "evil" kitty. The only terrorizing he does though is to Sebastian. Follows him everywhere!

Juliet worries me. She's been hiding or in the carrier mostly when she had been doing better earlier and her walking is worse. I know the zobaline is really just a bandaid over a bleeding jugular but I feel that I'm doing something at least. The original vet has to research?- this is exactly what the tech said- hasnt gotten back too us and the other vet we think we'd like to work with can't see us until next Saturday but we are on the list in case anyone cancels before then. So waiting and researching and hoping right now. Have I mentioned you guys are really awesome? This is the most Ive interacted with anybody outside of home and work. Im a workaholic and a little bit of an obsessive compulsive cleaner. Can't stand a dirty kitchen or clutter. I shudder at the thought.
Click to expand...
Well, Alicia - who wouldn't like someone who is workaholic, compulsive cleaner AND Shakespeare-lover? My kind of person!:D
So tell us: How is Juliet eating for you today? Did you get a BG # today? (My understanding is that the Zobaline really can help kitties, btw. And her neuropathy will likely lessen once her diabetes is under control, too. How are her 5 "P's" in general: Peeing, pooping, playing, preening and purring?

Re: The original vet - tech said vet "has to do research?" Well, you might look at that as a sign --- telling you how little they know about treating feline diabetes!
Re: New vet - do you mean this coming Saturday, or next Saturday, a week from this one?
 
AliciaG said:
Juliet worries me. She's been hiding or in the carrier mostly when she had been doing better earlier and her walking is worse. I know the zobaline is really just a bandaid over a bleeding jugular but I feel that I'm doing something at least. The original vet has to research?- this is exactly what the tech said- hasnt gotten back too us and the other vet we think we'd like to work with can't see us until next Saturday but we are on the list in case anyone cancels before then.
Click to expand...
By next Saturday do you mean 22 August, or 29 August, Alicia? If the latter I strongly suggest finding a vet who is in a position to prescribe insulin, because it sounds like Juliet really needs it. The vet who "has to research" may be well-intentioned but is not responding to the immediacy of Juliet's health needs. If her walking is getting worse then the high blood sugar is most likely doing more damage to her nerves and other internal systems (kidneys included).

Are you looking to treat Juliet with Lantus or Levemir? If yes, please find attached below the published, peer-reviewed study Management of Diabetic Cats with Long-lasting Insulins by Kirsten Roomp and Dr Jacqui Rand (the latter of University of Queensland). All the research that your vet needs is in that document, plus full details of the scientific, evidence-based Tight Regulation dosing protocol. I hope you find it helpful.


Mogs
.
 

Attachments

Last edited:
An afterthought: Tight regulation is a relatively aggressive protocol. FDMB also has a Start Low, Go Slow (SLGS) protocol which may better suit some cats and caregivers when daily mid-cycle testing is a challenge due to circumstances. (SLGS doses are held for longer, and dose reductions are made at a slightly higher BG threshold).


Mogs
.
 
AliciaG said:
Juliet worries me. She's been hiding or in the carrier mostly when she had been doing better earlier and her walking is worse. I know the zobaline is really just a bandaid over a bleeding jugular but I feel that I'm doing something at least. The original vet has to research?- this is exactly what the tech said- hasnt gotten back too us and the other vet we think we'd like to work with can't see us until next Saturday but we are on the list in case anyone cancels before then. So waiting and researching and hoping right now.
Click to expand...

It sounds like your original vet and tech aren't well-versed in feline diabetes. In fact, it sounds like they aren't knowledgeable at all in this area. I hope you can get in to the new vet soon.
 
Last edited:
Robin&BB said:
Well, Alicia - who wouldn't like someone who is workaholic, compulsive cleaner AND Shakespeare-lover? My kind of person!:D
So tell us: How is Juliet eating for you today? Did you get a BG # today? (My understanding is that the Zobaline really can help kitties, btw. And her neuropathy will likely lessen once her diabetes is under control, too. How are her 5 "P's" in general: Peeing, pooping, playing, preening and purring?
Click to expand...

Juliet is always willing to eat. The thing I've especially noticed lately is that she doesn't eat the entire portion in one sitting anymore since she is now on wet food as of two weeks now. She'll go back to it after a while if there is food left in her dish. I have considered giving less so that there is no "snacking" through the day until next feeding but I feel that she and the others get so little with only receiving two servings for the day. I'm terrified of no one getting enough and then I have the opposite set of problems.

We had been doing well with the BG's were steadily in the lower 200's with only 10 or so points difference until day before yesterday when it went from 212 to 317! I think it happened when I "tried" to take her outside for some exercise. She had a more interesting time laying down and trying to eat all the grass instead. :facepalm: I'm pretty sure it's the cause, and the numbers have slowly come down again, we were at 247 this morning.

The 5 P's are actually pretty steady. Peeing has actually lessened since the diet change and pooping is the same, nothing runny. Preening is good and she still tries to use the back legs for grooming though sometimes they don't quite make it all the way there. She has never been super playful or purry strangely enough. She's always been the more sedate serious cat though a string can still get her excited enough to take a whack at it. But you can feel her purr and she still tries to bite you if you get too aggressive with her tummy.:D It's just this laying in the carrier or half under the couch all day that has started.

I have a consultation with the first vet tomorrow (with that nice big consultation fee attached :arghh:) (there is even a scrip fee of $20.00, so that they can keep track of ito_O) so maybe we can at least get her started and see about the other vet soon. I don't have a consultation with the new vet until Saturday the 29th. :( But at least they have Saturday hours.
 
AliciaG said:
I have a consultation with the first vet tomorrow (with that nice big consultation fee attached :arghh:) (there is even a scrip fee of $20.00, so that they can keep track of ito_O) so maybe we can at least get her started and see about the other vet soon. I don't have a consultation with the new vet until Saturday the 29th. :( But at least they have Saturday hours.
Click to expand...

You have to pay a script fee so your vet can keep track of a prescription? I am not aware of vets charging for this. None of mine have ever charged me for a script.
 
Last edited:
Our vets only charge me a prescription fee when I request an Rx for something I need to get from a human pharmacy.
 
I am guessing that is unique to the UK, @Critter Mom (?) Either that or all the vets I've gone to have been very generous. But then so have I in giving them a lot of business.

I can't see the justification for a vet charging a fee to write out a script to "keep track of it". There's a thing called photocopying and duplicates.
 
Completely with you on the "keep track of it" (ahem) 'justification'. Sounds totally bogus to me. o_O

It's only relatively recently that UK consumers have been able to shop around for prescriptions from outlets other than their vets. Personally, I'm very happy to pay the fairly nominal fee for Saoirse's ondansetron Rx. Our vets offer wonderful telephone assistance any time, day or night, 365.25 days a year. The Rx fee helps to support the practice. I'm all for that: it's well-deserved. :)
 
Critter Mom said:
Completely with you on the "keep track of it" (ahem) 'justification'. Sounds totally bogus to me. o_O

It's only relatively recently that UK consumers have been able to shop around for prescriptions from outlets other than their vets. Personally, I'm very happy to pay the fairly nominal fee for Saoirse's ondansetron Rx. Our vets offer wonderful telephone assistance any time, day or night, 365.25 days a year. The Rx fee helps to support the practice. I'm all for that: it's well-deserved. :)
Click to expand...

How grand it would be to have vet telephone assistance any time of the day in the States!
 
Cat Ma said:
How grand it would be to have vet telephone assistance any time of the day in the States!
Click to expand...
Indeed. I must admit I was taken aback after joining FDMB and hearing about all the ER visits you good people have to make. Our own vets have a full out-of-hours emergency service. That said, I think that some UK vets may subcontract out their out-of-hours care to third parties. I am very grateful that should Saoirse ever need emergency treatment (Heaven forbid!) it is our own vets who will be there for her; in or out of normal surgery hours.

.
 
@Critter Mom , @Cat Ma - Okay, I'm gonna jump in here because my other vet is in Colorado ... and isn't that where you are, Alicia? (Unless you're from" Colorado & live elsewhere now.) But in Colorado, I've never had a vet - & I've lived there as far back as 1974 - charge me a 'script fee. I suspect the reason behind a "prescription fee" is because that vet practice wants you to get your insulin from that office. (Yikes! That must be something that's u&c on the Front Range, or in Vail or Aspen areas.)
 
Pueblo- the insane crazy crack of the earth place. I have lived in a lot of places and multiple states, but Pueblo takes the cake.
 
AliciaG said:
Juliet is always willing to eat. The thing I've especially noticed lately is that she doesn't eat the entire portion in one sitting anymore since she is now on wet food as of two weeks now. She'll go back to it after a while if there is food left in her dish. I have considered giving less so that there is no "snacking" through the day until next feeding but I feel that she and the others get so little with only receiving two servings for the day. I'm terrified of no one getting enough and then I have the opposite set of problems.
Click to expand...
Glad to hear Juliet is doing well with the "5 P's" (ha, mine has a barely-detectable purr, too) and that you have 2 vet appts. lined up.
I think others who have multi-cat households can give you some excellent tips on feeding routines (mine is an "only" cat).

One thing that helps in treating your diabetic cat is to start viewing her low-carb food as "medicine," too. Not only is it important that your kitty eats right after you test her BG and before you give a shot of insulin (you must always test pre-shot, to keep her safe), it's also important that she eats the proper amount of low-carb food daily for her optimum weight, regardless of whether you choose to feed only twice daily or in multiple meals. You need to be certain she can't get into anyone else's rations at any time of the day or night - as contraband food will wreak havoc on your ability to get her diabetes under control. Proper portion control applies even to the "diet-only" controlled diabetic cat (one not on insulin).

How much food would you say Juliet gets every 24 hrs these days?
 
AliciaG said:
Pueblo- the insane crazy crack of the earth place. I have lived in a lot of places and multiple states, but Pueblo takes the cake.
Click to expand...
Oh, wow - I hear you!!! Pueblo was one of the cities in which I held topic-input sessions with local water interests when I directed an annual western water conference in Colorado. (Could never get out of that town fast enough!) One of the things that always drove me nuts was that the "locals" in Pueblo pronounce the town's name like this: "PEE-ebb-low!" (What in the world is up with that???)
 
I'm not sure where this discussion came from but I would never 'pay' for a prescription - that's ridiculous. You pay the office visit, etc. and that's their payment. I would find a new vet if I get nickel and dimed like that whatsoever.
 
You know what I'd do? I'd (very politely) tell the vet himself/herself: "I really need that $20 to pay for my cat's insulin; and as I'm paying for a consultation fee, it would be an awfully big help to me if you could see your way clear to waive that prescription fee in our case." Never hurts to ask. (You'd be amazed at how many health care practitioners don't even know about some of the ridiculous "extra" fees their office administrators tack onto the bill. And sometimes, when you gently make one aware that your budget it tight, the doc will waive such a fee.)
 
Robin&BB said:
You know what I'd do? I'd (very politely) tell the vet himself/herself: "I really need that $20 to pay for my cat's insulin; and as I'm paying for a consultation fee, it would be an awfully big help to me if you could see your way clear to waive that prescription fee in our case." Never hurts to ask. (You'd be amazed at how many health care practitioners don't even know about some of the ridiculous "extra" fees their office administrators tack onto the bill. And sometimes, when you gently make one aware that your budget it tight, the doc will waive such a fee.)
Click to expand...

You're a lot nicer then me. Lol.
 
AliciaG said:
I have a consultation with the first vet tomorrow (with that nice big consultation fee attached :arghh:) (there is even a scrip fee of $20.00, so that they can keep track of ito_O) so maybe we can at least get her started and see about the other vet soon
Click to expand...

Ugh, I don't like the sound of the first vet. But let us know how the appointment goes tomorrow, and remember, you don't have to pay for anything but the consultation!

Don't let them bully you into buying anything from them. You should be able to walk out of there with a scrip for insulin and then you can shop around and find it cheaper somewhere else.

Good luck, paws crossed for a productive (and not too expensive) vet visit!
 
Status
Not open for further replies.
Back
Top