Trying to switch to Lantus, Vet is fighting against it

MindyC

MindyC

Member Since 2019
Grr... So a few of you saw my post about switching from Novolin to Lantus yesterday. After multiple calls to the vet's office, I have somehow drawn the short stick and am getting stuck with the old school guy that seems to have a bug up about changing his insulin. Last time he saw Max, which was 3 weeks ago, it was for a urinary tract infection. At that time, he tried telling me to increase his dose to 2.5U during the day and 2U at night and gave me a whole lecture about insulin resistance and how the doses will increase over time because of it.

He completely disregarded the fact that Max had only been on insulin for about 3-4 weeks at that point. Insulin resistance shouldn't have ever been a factor in his dosing at that point.

He won't call in a Rx for Lantus without seeing him. I know I'm going to get a lecture and a bunch of bull when take Max in tomorrow for a pointless fructosamine test. Please give me your best points about why Lantus should be used for cats instead of Novolin. I know if I walk in talking about "the depot" he's going to look at me like I have 3 heads. He's been great with my dogs and all other things related to Max, except this. And if he just tries to tell me to change his dose, we'll find a new vet (even tho the other guy is great). Based on my last conversation with him, he seems to have no use for home testing and thinks I should just be giving him shots without considering the fact that a too-high dose could kill him. :mad:
 
Good luck.... I went through all that with my vet. I even sent her the complete study of Lantus on diabetes cats going into remission which she found very interesting BUT.. she preferred using Caninsulin. At the end I was fed up so I went on my own, bought Lantus and started with this Forum; here I got all the information, experience and support my vet could not give me! I'm lucky in Canada you don't need a script for insulin, but I know many in the US are ordering insulin online from Marks Marine Pharmacy in Canada. Keep on with your vet for the things you're happy with and for the rest, it's your choice! :)
 
The thing that's killing me most is that he was on Lantus 9 years ago. And he went into remission in 6 weeks. There should be no argument. It's not like I don't know how to handle this, and I do know it's expensive and he's old. But without better sugar regulation, he's going to keep peeing somewhere that is not his litter box, and that is causing even bigger issues.
 
Oh Mindy, I feel for you! My old vet used ProZinc and we got quickly no where on it. I switched to a different vet and ask for an RX for Lantus and they were more than happy to oblige me.

Could you call some other vets in your area, ( I know you said yesterday that you were in the middle of nowhere, and tell them you have a diabetic cat that lost remission and your present vet with only RX novolin and you'd prefer to use Lantus again like you did 9 years ago. Of course, they are going to want to see you but your present vet is wanting to see him again as well.

See if that does it. If not maybe we can find some Lantus in the Supply Closet.
 
Thank you!

I do have an option for a vet that is closer, we just never switched after we moved (I don't know a whole lot about any of the vets at that office, tho). We have 3 available offices within a 30 minute drive, but one of them we will not return to any time soon (management issues and the vet made some bad decisions regarding our now 6yo dog when he was a puppy). If things fail with the vet tomorrow, I can call the office and request a conversation with the newer-school vet. If all else fails, I have the newer guy's home number since his wife was our previous vet (not the one that made the bad call on the puppy) who initially diagnosed Max, and at one point our daughters were in Scouts together. I don't want to be "that" person, but I'll play that card if I absolutely must. ;)
 
MindyC said:
Please give me your best points about why Lantus should be used for cats instead of Novolin.
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Do you think you will show the SS to your vet?
If yes point his attention to how high Max goes up by the end of 12 hours cycle which could possibly mean that Novo does not give enough duration and that you hope Lantus would last longer in his system. It may or may not work.
I would not open "the depot type" discussion with a vet either - learnt the hard way that a lot of vets hate pet parent trying to get educated/ informed/ involved.
I pay $100 for useless Fructo test (easy money for my vet made in less than 10 min) and he writes Rx I need without fuss. Seems to work well so far, knock knock.)
Very best of luck to you and Max.
 
Tanya and Ducia said:
Do you think you will show the SS to your vet?
If yes point his attention to how high Max goes up by the end of 12 hours cycle which could possibly mean that Novo does not give enough duration and that you hope Lantus would last longer in his system. It may or may not work.
I would not open "the depot type" discussion with a vet either - learnt the hard way that a lot of vets hate pet parent trying to get educated/ informed/ involved.
I pay $100 for useless Fructo test (easy money for my vet made in less than 10 min) and he writes Rx I need without fuss. Seems to work well so far, knock knock.)
Very best of luck to you and Max.
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I have actually emailed the link to the SS to the office twice. The first time got a return of a 2U to 3U dose, which failed in a few days. I don't know which vet saw it, but it wasn't the good guy that did the initial diagnosis (I think they have a new doc we haven't seen yet). I sent it yesterday in hopes that it would save the visit, but clearly it did not. I don't think he knows how to read it, believes that using a human meter is worthless, and that home testing is also worthless so he's not going to look at it anyway--especially considering it took 24 hours before he gave the tech an answer about it and it still required a visit. I'll print it and take it, but I don't have high hopes he'll actually look at it. I do have hope that since the appointment is at roughly AM+10, he'll see the duration is bad, though. Keeping my fingers crossed that he'll write the script for that alone and not just try to change the dose.
 
Wendy&Neko said:
Treat this patient (the vet) with facts and guidelines from his own profession: http://www.felinediabetes.com/FDMB/...nagement-guidelines-for-dogs-and-cats.195960/
The section on treatment for cats starts page 3, uses words like Lantus, Levemir or Prozinc, same as we do here.

So far I have had pretty good luck with presenting published papers to my vets that supported my position.
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Thank you, I'll print that out and take it with me! I think I actually turned that paper up in a google search a little while ago. Clearly I'm not focusing well on work today...:)
 
The best point I can give you is the recommendation by the American Animal Hospital Assn. This is the link to their 2018 guidelines for diabetes management in dogs and cats.They recommend Lantus and Prozinc for cats. I might considering tactfully suggesting that if he disagrees, he needs to do some reading as provided by one of his professional associations. Novolin is suggested ONLY for dogs. The last I looked, cats are not small dogs. (FYI - in the link I provided, there's a link to the downloadable PDF report. You can always print it out and bring it to this vet.) I firmly believe in presenting the data and asking a recalcitrant vet to show you where he's getting his information (and years of experience do not count).
 
So I ended up seeing the new new vet today. They did a fructosamime test (wasted $37.50, but whatever), and she agreed the best insulin for cats was lantus and wrote a new script. We’re starting at 1U and going from there. She liked the spreadsheet and seemed impressed by the detail, so that was good at least. Still don’t know if she knows how to read it, but she didn’t tell me to stop doing it and also didn’t ask me to bring him back in 2 weeks for another test.

We also discovered he has a heart murmur and arthritis in his knees and hips. She said between the two to give him a baby aspirin every 3 days, so he got that tonight after dinner. Hopefully we’ll see some good results with the lantus soon! :-)
 
MindyC said:
So I ended up seeing the new new vet today. They did a fructosamime test (wasted $37.50, but whatever), and she agreed the best insulin for cats was lantus and wrote a new script. We’re starting at 1U and going from there. She liked the spreadsheet and seemed impressed by the detail, so that was good at least. Still don’t know if she knows how to read it, but she didn’t tell me to stop doing it and also didn’t ask me to bring him back in 2 weeks for another test.

We also discovered he has a heart murmur and arthritis in his knees and hips. She said between the two to give him a baby aspirin every 3 days, so he got that tonight after dinner. Hopefully we’ll see some good results with the lantus soon! :)
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Oh hooraay! It is SO frustrating when vets refuse to try something "new" to them. A few minutes of his own research would have given him the information. So far so good with the new vet. I hope you can continue without needed further fructosamine tests. Sorry to hear about the murmur and the arthritis. I hope the aspirin helps!
 
What is the strength of the baby aspirin? I don’t know a lot about heart issues in cats but @Wendy&Neko is experienced with it and may like to comment on a baby aspirin every three days.
Great you have been able to get the Lantus!
 
Bron and Sheba said:
What is the strength of the baby aspirin? I don’t know a lot about heart issues in cats but @Wendy&Neko is experienced with it and may like to comment on a baby aspirin every three days.
Great you have been able to get the Lantus!
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Thank you! It is a delayed release 81mg. I bought the coated ones so they’re easier to swallow and less likely to upset his stomach.
 
Info on Asprin use in cats...

https://www.marvistavet.com/aspirin.pml

Aspirin will reduce blood flow through the kidney which is likely to make pre-existing kidney disease much worse.

Enteric coating of aspirin may alter the way aspirin is absorbed in the stomach. The pills tend to stick to the stomach lining instead of dissolving properly. If enough tablets accumulate, overdose and death can occur. We recommend non-enteric coated aspirin only.
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Sorry, been sick so late to reply.
MindyC said:
We also discovered he has a heart murmur and arthritis in his knees and hips
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Not all heart murmurs need treatment. Some are harmless and may be just caused by age related changes to the heart. My Neko’s murmur was like that. An echocardiogram (heart ultrasound) will provide more detail. Aspirin is not a common treatment for arthritis. In the US, Adequan is commonly used, Cartrophen is used elsewhere.
 
Wendy&Neko said:
Sorry, been sick so late to reply.

Not all heart murmurs need treatment. Some are harmless and may be just caused by age related changes to the heart. My Neko’s murmur was like that. An echocardiogram (heart ultrasound) will provide more detail. Aspirin is not a common treatment for arthritis. In the US, Adequan is commonly used, Cartrophen is used elsewhere.
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Thank you! I’ll tak to the vet about this the next time we are there. In the meantime we’ll skip the aprin.
 
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