Vet specialist for Allie's high insulin usage

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Breelynne

Breelynne

Member Since 2023
Hope I am posting this in the right forum.

Allie my sugar kitty has been on Lantus for a few months and her doses just keep increasing. I reached out to my vet for switch her over from Lantus to glargine.

Got this back in the email from the vets office just now.

In regards to the insulin, as glargine is only "biosimilar" to lantus so Dr. Storts would not recommend switching the insulin. They want me in on Tuesday at 5pm to provide a consultation and come up with a treatment plan for controlling Allie's diabetes.

From their email.

We can set up an appointment with the veterinary internist this Tuesday at 5:00pm. The doctor would be able to provide a consultation and come up with a treatment plan for controlling Allie's diabetes. Please let me know how you would like to move forward.


The specialist exam and consultation is $200, this does not include diagnostics. Allie would need to be present for the exam, however she would not need to fast prior to her scheduled appointment. Would you like me to set up this appointment?

I'd be willing to do this if they are going to run the IGF-1 and IAA tests. I've never seen this "specialist" before.

Not sure what they are going to do and am I wrong for questioning them? I recently switched vets because the other vet that diagnosed her were not proactive enough.
 
I'll do my best at guessing.

First, glargine is the generic/chemical name for Lantus. The patent has lapsed and there are now "biosimilars" available. They are the same drug. The biggest difference is that the biosimilars cost a lot less.

Many vets are not terribly familiar with acromegaly. They are often taught that it's a very rare condition. (I believe that prevalence is about 25% which does not make it rare!) Further, many vets do not encourage that cats are home tested. As a result, there's not great data for how well a cat is responding to insulin other than what's seen in the vet's office. It's likely that the potential for a high dose condition, such as Acro or insulin auto-antibodies is missed.

If this were my cat, I would ask what the reason for the consultation is. How familiar is your vet with treating feline diabetes? I would ask how many cats he's treated. If he's not familiar or has never had a cat on a higher dose, it's not unreasonable to ask for a consultation. However, if it's a matter of his lack of training, I would ask if it would be better to transfer your cat's care to an internal medicine or endocrine specialist. Alternatively, your vet could consult with the specialist so he improves his knowledge but that's providing you like the vet and you're OK with this sort of arrangement.

So here's my anecdote about specialists. When one of the other moderators was new to FDMB, her vet suggested she see a specialist regarding her cats FD. The internal med vet proceeded to tell her about chronic Somogyi rebound. This is a bit of a hot button topic for me since it is very old and poorly done human research (i.e., first published in 1938 in a local, St. Louis medical newsletter and has never been replicated and not pertinent to newer insulins) and has since been refuted in cats. A specialist is only as good as how current the person is with the research and internal medicine covers a lot of ground. I might be curious why an IM vet vs. a vet who's an endocrinologist. There are a lot of subspecialty areas in internal medicine! I wouldn't want a kidney specialist treating a cardiac condition!
 
Sienne and Gabby (GA) said:
I'll do my best at guessing.

First, glargine is the generic/chemical name for Lantus. The patent has lapsed and there are now "biosimilars" available. They are the same drug. The biggest difference is that the biosimilars cost a lot less.

Many vets are not terribly familiar with acromegaly. They are often taught that it's a very rare condition. (I believe that prevalence is about 25% which does not make it rare!) Further, many vets do not encourage that cats are home tested. As a result, there's not great data for how well a cat is responding to insulin other than what's seen in the vet's office. It's likely that the potential for a high dose condition, such as Acro or insulin auto-antibodies is missed.

If this were my cat, I would ask what the reason for the consultation is. How familiar is your vet with treating feline diabetes? I would ask how many cats he's treated. If he's not familiar or has never had a cat on a higher dose, it's not unreasonable to ask for a consultation. However, if it's a matter of his lack of training, I would ask if it would be better to transfer your cat's care to an internal medicine or endocrine specialist. Alternatively, your vet could consult with the specialist so he improves his knowledge but that's providing you like the vet and you're OK with this sort of arrangement.

So here's my anecdote about specialists. When one of the other moderators was new to FDMB, her vet suggested she see a specialist regarding her cats FD. The internal med vet proceeded to tell her about chronic Somogyi rebound. This is a bit of a hot button topic for me since it is very old and poorly done human research (i.e., first published in 1938 in a local, St. Louis medical newsletter and has never been replicated and not pertinent to newer insulins) and has since been refuted in cats. A specialist is only as good as how current the person is with the research and internal medicine covers a lot of ground. I might be curious why an IM vet vs. a vet who's an endocrinologist. There are a lot of subspecialty areas in internal medicine! I wouldn't want a kidney specialist treating a cardiac condition!
Click to expand...


First let me say thank you! When I got the first email back about the insulin being "biosimilars" I was like ...... OK then. That made me question WTH they were saying.

I'm going to take the excellent points you expressed in your response and call them first thing in the morning. I'm lucky Allie is a an awesome patient, I only want the best for her so this is why I'm questioning what they are telling me.
Thank you for pointing out the finer details that I should have caught. 3 months into this and with everything else going on sometimes I feel a little overwhelmed. It's good to take a step back and have someone else who's been on this road set me straight and point out what I should be asking. I printed up those 2 tests Friday night and was actually going to stop by this week to see what they thought about getting Allie tested.

I'm glad I posted this! Never settle if you feel something is off. Always ask questions!
 
First, regarding biosimilars, might want to point the vet to this release from the FDA which declared glargine an interchangeable biosimilar with Lantus.

Second, if I had a dollar for every vet I've seen here reluctant to test for, much less treat for acromegaly and/or IAA, I'd be rich. My own vet thought Neko's dose was too low to test. My vet's clinic practice owner called them "exotic tests". Many vets "of a certain age" were taught "this is acromegaly, you'll never see it". Recent research does show it's about 20-25% of diabetic cats who has acromegaly, the variability being where the research was done. After much begging and asking to be humoured, and showing them how to get the tests done, I finally had success. To be fair to them, the research study showing how frequent came out in 2015, after Neko's diagnosis time. Let me know if you want links to papers to send to the vet. Oh, and one of those papers showed the dose of acros varied with some as low as 1 unit, but the average at 7 units.

With diagnosis, we can help you decide on treatments, if needed. When I finally got positive test results, my vet also wanted to refer me to an internist for a diagnosis and treatment plan. I said no thanks, the tests had given me the diagnosis and FDMB had already given me a treatment plan and I booked SRT a week later. Using part of the money saved from the cancelled internist appointment. Not long after, Neko's vet discovered another acro in her practice. Her eyes were opened, and she was willing to learn with me. A few years later, I started taking Neko to an acupuncture vet. She started reading articles before our first visit, when I'd told the front office she had acromegaly. Love that about the vet, she's now my current vet. Anyway, after much discussion, that vet realized that a stray she'd taken on from her neighbourhood (but no longer alive), had probably had acromegaly.

Even though a lot of what I said is about acromegaly, as we know how common it is, IAA should also be tested. There is very little research done on it, but we've seen several cats who have had IAA by itself. And it's cheaper to do both tests at the same time.
 
Wendy&Neko said:
First, regarding biosimilars, might want to point the vet to this release from the FDA which declared glargine an interchangeable biosimilar with Lantus.

Second, if I had a dollar for every vet I've seen here reluctant to test for, much less treat for acromegaly and/or IAA, I'd be rich. My own vet thought Neko's dose was too low to test. My vet's clinic practice owner called them "exotic tests". Many vets "of a certain age" were taught "this is acromegaly, you'll never see it". Recent research does show it's about 20-25% of diabetic cats who has acromegaly, the variability being where the research was done. After much begging and asking to be humoured, and showing them how to get the tests done, I finally had success. To be fair to them, the research study showing how frequent came out in 2015, after Neko's diagnosis time. Let me know if you want links to papers to send to the vet. Oh, and one of those papers showed the dose of acros varied with some as low as 1 unit, but the average at 7 units.

With diagnosis, we can help you decide on treatments, if needed. When I finally got positive test results, my vet also wanted to refer me to an internist for a diagnosis and treatment plan. I said no thanks, the tests had given me the diagnosis and FDMB had already given me a treatment plan and I booked SRT a week later. Using part of the money saved from the cancelled internist appointment. Not long after, Neko's vet discovered another acro in her practice. Her eyes were opened, and she was willing to learn with me. A few years later, I started taking Neko to an acupuncture vet. She started reading articles before our first visit, when I'd told the front office she had acromegaly. Love that about the vet, she's now my current vet. Anyway, after much discussion, that vet realized that a stray she'd taken on from her neighbourhood (but no longer alive), had probably had acromegaly.

Even though a lot of what I said is about acromegaly, as we know how common it is, IAA should also be tested. There is very little research done on it, but we've seen several cats who have had IAA by itself. And it's cheaper to do both tests at the same time.
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I know medications and agree 100% with you that's where it took a turn and just got worse from there. I am new to the area I'm am living before I had the same vet for 30 years! I do miss him.

I'll let you know how it goes and if I need those links tyvm! Allie is right at 6 units right now. I'm sure they are going to question me about the dosing she is currently at.

Guess it is better to get a DX sooner than later. I'll be calling them in the morning and asking some major questions they need to be ready to answer before I show up on Tuesday.

Good for you being proactive and doing all you did for Neko! I'm trying to accomplish the same thing here that is why I joined. Thank you for sharing what you did and what you know. All my life I've had cats and I've never heard of either condition, though Allie is my first sugar kitty.

I think you gave me a bunch of links and that is where I printed the information for both tests to give the vet. I've been reading! I've also been doing some sleeping when I can!

Hope you have a good night I'm going to take Allie's BS one more time before bed.
 
Breelynne said:
In regards to the insulin, as glargine is only "biosimilar" to lantus so Dr. Storts would not recommend switching the insulin.
Click to expand...

Take a look at this page, from the manufacturer of Lantus: https://www.lantus.com/how-to-use/insulin-glargine-u100

The people who manufacture Lantus are literally saying that their generic version is identical. There are other generics made by other companies where your doctor might have an argument (not a very good one). But this option is made by the same people on the same machines in exactly the same way. I’m pretty sure it’s the same manufacturing line and they just slap a different sticker on at the end.

Are you in Canada? If so you can buy your insulin without a prescription. If not hopefully he’ll read this page and give you a prescription for Insulin Glargine.
 
Breelynne said:
I'd be willing to do this if they are going to run the IGF-1 and IAA tests. I've never seen this "specialist" before.
Click to expand...
Will your vet send a sample out for these tests?
I have had mixed results from specialists. My MurrFee was in same situation and the specialist really did nothing special. Just adjust dose and do curves. Later after my research I had my vet send out a sample to MSU, they are only place in USA that does IGF-1 and IAA tests. The result for the IGF-1 was > than the testing could measure. I went to same specialist practice but different vet (the other one has left) and she was helpful and knowledgeable about acromegaly. For my current acromegaly cat, Snuffles the vent sent out the samples and based on info from the Acromegaly form prescribed cabergoline in addition to the insulin he was taking. I did not see a specialist. Snuffles is doing good.

If your vet can sent out the sambpe for the tests he may require a specialist to do other than just insulin.
 
Larry and Kitties said:
Will your vet send a sample out for these tests?
I have had mixed results from specialists. My MurrFee was in same situation and the specialist really did nothing special. Just adjust dose and do curves. Later after my research I had my vet send out a sample to MSU, they are only place in USA that does IGF-1 and IAA tests. The result for the IGF-1 was > than the testing could measure. I went to same specialist practice but different vet (the other one has left) and she was helpful and knowledgeable about acromegaly. For my current acromegaly cat, Snuffles the vent sent out the samples and based on info from the Acromegaly form prescribed cabergoline in addition to the insulin he was taking. I did not see a specialist. Snuffles is doing good.

If your vet can sent out the sambpe for the tests he may require a specialist to do other than just insulin.
Click to expand...

All I did was sent a quick email first stating I wanted to switch insulin types to the generic since she was using such a large dose and when they said "NO" that the generic was not the same then came back with....Well you need to see the specialist here (they just said that Internal Medicine which could mean a lot of things). I'm going to call them in a little while I have a few questions and those tests are part of what i am going to ask about.

I'm glad to hear Snuffles is doing good and that you were proactive as to motivate your vet to be the same. That is what I'm asking of mine but sometimes they'd rather not listen. If mine wont do the tests I'll find one that will.
 
Jacques and Pumpkin said:
Take a look at this page, from the manufacturer of Lantus: https://www.lantus.com/how-to-use/insulin-glargine-u100

The people who manufacture Lantus are literally saying that their generic version is identical. There are other generics made by other companies where your doctor might have an argument (not a very good one). But this option is made by the same people on the same machines in exactly the same way. I’m pretty sure it’s the same manufacturing line and they just slap a different sticker on at the end.

Are you in Canada? If so you can buy your insulin without a prescription. If not hopefully he’ll read this page and give you a prescription for Insulin Glargine.
Click to expand...

Thank you so much for that link...I almost want to include in my email can you tell me why you are stating the 2 insulins are not the same? Here is the mfg website. Makes me question their specialist and motives. If they are not knowledgeable enough do I even want them treating my cat?

I am in the USA but I know there is a Canadian Pharmacy I can get the insulin. Think I need the first initial prescription.
 
Hi Lynne in case you do get the generic and don't order from Canada
Check this out
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1




Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.
Just call around and see who has the best price
@Breelynne
 
Diane Tyler's Mom said:
Hi Lynne in case you do get the generic and don't order from Canada
Check this out
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1




Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.
Just call around and see who has the best price
@Breelynne
Click to expand...

Thanks for the info. I do appreciate greatly. I have the GoodRX card and they even have an 1-800 number if you have an issue with the pharmacy not giving you a discount because it is a pet and not a person. The script has to have the DEA number on it and the coding on the RX card has to be right also.I don't know if I'll get another script they are kind of holding me hostage with their most recent email.
 
Got a response from my vets office this morning and feel like I'm being held hostage!
Good morning Ms. Blalock,

He is a board certified internal medicine veterinarian and has dealt with many diabetic animals over the years. The insulin would be a great question to ask Dr. ______ tomorrow at the appointment. We will see you tomorrow at 4pm.

The visit is $200.00 and anything they do extra I'd be charged for. I asked what diagnostics would be done and no answer to that question, they skipped right over that!
 
Just unbelievable , good luck with the visit tomorrow :bighug::cat:
I know nothing about this but I see that Wendy said it's cheaper to do the both tests at the same time
the IGF-1 and IAA tests
And Larry said
I had my vet send out a sample to MSU, they are only place in USA that does IGF-1 and IAA tests. . I wish you all the best, just stick to your guns. These vets think we are made of money :bighug:
I'm sure Wendy can give you more advice
 
Last edited:
Diane Tyler's Mom said:
Just unbelievable , good luck with the visit tomorrow :bighug::cat:
I know nothing about this but I see that Wendy said it's cheaper to do the both tests at the same time
the IGF-1 and IAA tests
And Larry said
I had my vet send out a sample to MSU, they are only place in USA that does IGF-1 and IAA tests. . I wish you all the best, just stick to your guns. These vets think we are made of money :bighug:
I'm sure Wendy can give you more advice
Click to expand...

Well in the last email I told them my mom had a doctors appointment at 1:45pm and she is having a test done and that I did not know how long the test would take but that I could call and ask. Their reply said to let them know and that they would see me at 4pm....They moved the appointment up and hour?????? :banghead::banghead::banghead:
 
Breelynne said:
Well in the last email I told them my mom had a doctors appointment at 1:45pm and she is having a test done and that I did not know how long the test would take but that I could call and ask. Their reply said to let them know and that they would see me at 4pm....They moved the appointment up and hour?????? :banghead::banghead::banghead:
Click to expand...
I thought the appt was for 4Pm in the first place
 
Sigh.....

How about calling and asking to speak to the practice manager? Perhaps telling them that you've just moved to the area and have already been unhappy with another vet and you've had very high hopes for their group. If it were me, I'd mention that it's disconcerting to not be given a rationale for scheduling an appointment with a specialist at a considerably greater cost than a routine vet visit. Unless you can be given a reason for the visit, you will happily bring Allie in for a blood draw so they can order IGF-1 and IAA labs from Michigan State. I'd also let the practice manager know that you were given incorrect information about glargine and its biosimilars. Perhaps the practice manager could appreciate how the interactions with the front desk staff is causing you to have a crisis of confidence with their practice.

FWIW, are there any cats only practices in your area?
 
Sienne and Gabby (GA) said:
Sigh.....

How about calling and asking to speak to the practice manager? Perhaps telling them that you've just moved to the area and have already been unhappy with another vet and you've had very high hopes for their group. If it were me, I'd mention that it's disconcerting to not be given a rationale for scheduling an appointment with a specialist at a considerably greater cost than a routine vet visit. Unless you can be given a reason for the visit, you will happily bring Allie in for a blood draw so they can order IGF-1 and IAA labs from Michigan State. I'd also let the practice manager know that you were given incorrect information about glargine and its biosimilars. Perhaps the practice manager could appreciate how the interactions with the front desk staff is causing you to have a crisis of confidence with their practice.

FWIW, are there any cats only practices in your area?
Click to expand...

When I switched to them I told them I had an issue with the last vet who talked about everything under the sun but treatment for your cats diabetes. I'll print this out with some questions and stop on my way home from my doctors appointment. Thanks for pointing out about talking to the practice manager. After having the same vet for 30 years dealing with a new vet(s) is overwhelming. Thanks for your guidance.
 
Allie has an appointment with her old vets office on the 12th. I'm reaching out to them this morning to make sure everyone is on the same page. I got a hold of a FB group member who lives near me and her and one of the admins spent a lot of time with me last night going over all the details.
 
Good luck with the vet appointment.
Breelynne said:
got a hold of a FB group member who lives near me and her and one of the admins spent a lot of time with me last night going over all the details.
Click to expand...
Can you share what you were talking about? and which FB group? Not all are created equal. FDMB is a open peer reviewed group, so we like to keep discussions where everyone can see them.
 
Wendy&Neko said:
Good luck with the vet appointment.

Can you share what you were talking about? and which FB group? Not all are created equal. FDMB is a open peer reviewed group, so we like to keep discussions where everyone can see them.
Click to expand...
Feline Diabetes FB page. This groups FB page I belong to both.
I remember a few members from my area looking for a good vet so I posted my dilemma hoping one of the members would see the post and they did.

Post I made to FB. I also posted here in the Health Forum board.

"I am having issues with my current vet and they are holding out on my insulin for my cat. I emailed them asking if I could get the generic for Lantus (Glargine) and they told me the doctor would not prescribe it because it is not "biosimilar". I emailed them the mfg. website and told them it is the same thing with a different label.
Now they said that would be a great question for the "specialist" and that I need to pay $200.00 just for a consult. Any diagnostics would be extra. I asked for an example regarding the diagnostics (hoping they would mention testing for the IGF-1 and IAA tests) and they totally blew off any mention of the diagnostics and wanted an answer if I'll be in tomorrow or not.
I also asked what their Internal Medicine (specialist) doctor specializes in and they emailed me back a generic answer-he is a board certified internal medicine veterinarian and has dealt with many diabetic animals over the years.
Now I feel like I am stuck in between a rock and a hard place.
Not sure if I can ask here who can recommend a vet that will be proactive with me and my Allie. These are questions I'd ask my own doctor and it shouldn't be any different with a vet.
Not bashing my current vets office but just not happy with the current treatment or the feeling there is a lack of said treatment."


I also included Allies SS in the email to the vets office. All I wanted to do is to switch to Glargine and was told by the doctor that it was not a "biosimilar" for Lantus and that he would not prescribe it. After I sent the mfg. website https://www.lantus.com/how-to-use/insulin-glargine-u100 they then sent an email stating that for $200 bucks I could come and see a different doctor but that visit would be 200 bucks without any diagnostics. That doctor specializes in Neurology not diabetes.
I emailed them and told them my mom had an appointment at 1:45 today that I had no idea how long her test would take. They wanted a commitment for me to be there at 5pm today and pay $200.00 end of story. When I questioned their last email to me concerning the diagnostics the time moved from 5pm to 4pm :banghead: not sure if that was a typo or not.


I chatted with a lady who lives right down the road from me and she knew exactly who the vet was that I was talking about. We went over Allies food, history, amount of insulin she is on they even looked at her spreadsheet. The original vet I saw for Allies DX was one of those your cat has diabetes come get the insulin give her 2 units and made me a follow up appointment for 3 months!

Being a diabetic myself I know this disease. I figured OK I had seen the forum I know what diabetes is and I can do this. I thought Allie had a UTi and asked the vet to get her in and they told me 2 weeks! No she is diabetic. So that is why I ended up at the other vets.
The lady that lives near me told me who to deal with at the other office. I still have my follow up for May 12th so Thursday I'll call them and ask to see one of 2 ladies there that are DVM's and a brief history of what is currently going on with Allie they already know I went to the ER vet because they could not get me in.

I had the same vet for 30 years and I miss him!!!!!!
 
Good to see it was the FB associated with FDMB. Some of the others I wouldn't trust. Good luck with the vet recommendations. I dread the day my vet retires.
 
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