Newly diagnosed cat: lantus or levemir?

Hello, brand new to this forum. My cat Vivian, on 5 mg daily prednisolone for large intestine inflammation, had a blood glucose test after I noticed she was drinking and urinating a lot last week. Her blood glucose was 352 Saturday and the vet wants to put her on glargine, at least until we can taper the pred (and add chlorembucil) which will hopefully reverse high blood glucose. So many questions, but I'll start here. The vet recommends glargine because she said it gives the cat the best chance for remission. She said it would be about $100 per bottle. Then I got a phone message saying the pharmacy will charge me $375 per bottle and it will expire before I can even use it all. Is this a crazy price for this, and have others tried an alternative and less expensive insulin successfully in a similar situation?
thank you
Laura

 

Lantus and Levemir cost about the same with usually Levemir being slightly more.
Most of us use the disposable pens and use a syringe to draw the insulin out and inject it in the cat. The pens are sold as a package of 5 3 ml pens. The vial is 10 ml. Most caretakers can use up a whole pen before it goes bad. Per ml the disposable pens cost more but it is usually cheaper sine you can use it all up which is not the case with the vial.

Some of us here order Lantus and Levemir from here:
https://rxcanada4less.com/
A lot less that if purchased in the USA.

 

Since the diabetes might be induced from the prednisolone, you might try going to the Lantus site and applying for their $25 a pen discount. You need to register your cat as a human 18 years old. Then you may need to shop around to find a pharmacy that will sell you one pen. Many Targets will do that. I did buy my last box of pens from Marks. Sorry about the possible small cell. Many treat it for years successfully though. There are two yahoo sites you might want to join. A really good vet responds to both.

 

If you'll need to keep on with the steroid, I'd go with Levemir (Detmir). Lantus tends to sting at higher doses.

 

I found a pharmacy that will sell me a single Lantus pen, and I got the discount card from Lantus, pharmacy said they will try to apply discount. Thanks for information -
I'm confused about the tips/syringes. Pharmacist said he would sell me tips that would be fine for injecting a cat and doesn't know how I would get insulin into a syringe from the pen. Do people on here use the pen tips that are purchsed with the pen? If not, are you saying you can get insulin from the pen into a small syringe?
thank you

 

Inside the pen is a small vial that can be used with a syringe. One problem with the pen tips is that the pens can only be set for full units. You many need to shot a partial unit (like 1.5 or .75 units) of insulin.

 

Get U-100 syringes
3/10 mL (aka 3/10 cc)
with half unit markings (all of WalMart's 3/10 syringes have half unit markings)
needle thickness options are: 29 (thicker) , 30, 31 (thinner)
needle length: short or long

 

I'm going to try to use the discount card and buy the Lantus pen. The vet has never heard of using regular syringes with pens, and the pharmacist recommended against it - maybe he wants to sell the tips? - but the vet said if I have "found a hack" let's try it out. I watched a couple of videos, one on this site that shows how to get insulin from the pen into a syringe and another that shows using the actual pen tips on the cat. I also read on this site that it is not recommended to refrigerate the pens b/c it "alterd the administration by the pen". Not sure what that means, but shouldn't the insulin be refrigerated?
Also, my cat has developed diarrhea in the last few days, which is the original reason she has been taking pred. Is untreated high blood glucose known to cause diarrhea?
thank you

 

Refrigerating an in-use pen can get air int the little vial of the pen and result in reduced amount of insulin being injected since air is compressible. This is because fo the thermal expansion and contraction of the temperature change of in-out-in-out of the fridge.
Also, with the pin you should leave the pen needle in for at least 6 seconds which can be hard fro a cat. Otherwise you can get a drop or two of insulin leaking out which means that was not injected. This is a concern with low does like on to two units.
I used a a Levemir pen with needles for my MurFee but he was on 18 units twice daily so a drop of two of insulin lost was not a concern. I refrigerated the pen but then again at 18 units a little air is not really a concern.
I got the Levemir pens and pen needles together on Craig's list so why not use the pen needles.

 

I understand refrigerating the pen with the needle tips is not recommended. If you are taking the vial out to use it with syringes, refrigerating is fine, and makes the insulin last a really long time. Pharmacists are really not up on how to "hack" (I love that term for what we do!) human drugs for cats. They just know what the manufacturer recommends.

So, refrigerate. Lev shouldn't be shook or rolled as it doesn't separate. And with the cost of it, handle like eggs - a bunch of us have dropped our insulin, much to our dismay.

 

I am hoping to start insulin with Vivian this evening, will use a pen with syringes, both the vet and pharmacist remain confused about how or why I would do this, so I am relying on the so far great information I have received here, and videos I have watched. One thing that confuses me though is whether or not to inject air into the pen before extracting insulin. One video says inject the amount of air as insulin you need into pen before extracting insulin; the other says do NOT do this. So - air or no air?
Also, I haven't even got my mind around blood testing yet, so I think Vivian will spend a day with the vet to get her "curve" done in a few days. What type of blood testing device is recommended/easiest on the cat?

 

You do not inject air into the pen. As you draw insulin form the pin the movable stopper in the pen vial will move twards the tip

 

Thank you. I purchased a Lantus pen from the pharmacy - they couldn't get the discount because a veterinarian and not a human MD had called in the prescription - and I got veterinary insulin syringes from the clinic. Vivian's first few injections have gone well. I did not inject air into the pen, but isn't it strange that a feline veterinarian would make a youtube video instructing to do so? There's a lot of conflicting information out there on all facets of feline diabetes treatment, so just taking one step at a time. For instance there are videos and recommendations to inject on back of neck and then there are recommendations specifically against it b/c of poor blood supply. I am injecting at back of neck because that is where I have experience giving shots to this skittish cat without freaking her out. She's on a tiny starter dose, I don't even have a BG tester yet. The vet told me I shouldn't even test BG daily unless meds or food or dose is changed or I'll make myself crazy -
Next step is to get some advice, watch videos and get a BG tester. What device do people use for their cats? I can't be home to test Vivian every two hours this week after 3-5 days of insulin to make a curve, vet says to bring her in there for a day. I have read stress of visit raises BG so doing a curve at the clinic is useless, even though the vet and others say it's fine to do this way just more expensive. All very confusing. Advice on BG testing device, injection sites, insulin curve welcome.

 

Uh Oh. . .You said veterinary syringes.
What color is the cap - orange or red?
You should have U-100, orange cap, insulin syringes, not red cap, U-40, insulin syringes.
The wrong syringes may cause an incorrect dose!

 

The veterinarian sold me a large canister U-100 orange cap insulin syringes and told me how much Lantus insulin to put in them, so I'm pretty sure I'm giving Vivian the correct dose. I guess my vocabulary is not accurate because I don't know much about the disease and its treatment, which is why I am asking questions here, such as the ones I asked about BG testing kits for cats, insulin curves and injection sites.
I thought insulin syringes sold to me by my veterinarian were veterinary insulin syringes?

 

As long as they say U100, you are fine. Most vets only carry syringes for U40 insulins, which is why BJM was worried.

U100 and U40 refer to the amount of dilution of the insulin. A U-100 insulin has 100 units of active insulin in each mL of liquid. A U-40 insulin has 40 units of insulin in each milliliter (mL) of liquid. Using the correct syringe is with your insulin very important. Most of the insulins created specially for cats and dogs are U40. Most human insulins are U100, including Lantus.

 

Whew! That's exactly why I was checking! You've got the correct syringes. You can purchase them at local pharmacies when they are U-100 as those are standard diabetic syringes. Some states require a prescription, so check on that.

 

Hi Laura!
* BG testing advice - assuming you're in the USA, many use Walmart's 'ReliOn' brand 'Confirm' or 'Micro' meter. It takes the smallest drop of blood which is great for starting. That will also allow you to go purchase strips quickly.

* Injection sites - it's good to alternate between fatty area behind the front legs and in front of the rear legs on each side. Dakota (my current sugar baby) does fine with scruff shooting but I alternate as often as he's comfortable. He lets me know quickly when he's 'touchy' on his flanks by giving me 'THE' look and moving away...I shoot scruff those times.

* Insulin curves - yes lots of cats are stressed at vet which raises bg. Doing curve at vet doesn't give the true picture. Dakota rises about 75-90 points just because he's at the vet's office. You can do it at home - just test every 2 hours for a full cycle.

Insulin syringes are insulin syringes - dependent on the insulin, not the human or animal.

Hope this helps! Keep asking questions when you don't quite understand - that's the BEST way to learn! No one's going to get upset with you, we've all been there!

HUGS

 

Home testing is a safety thing

1) to make sure it is safe to shoot, based on the collected data

2) to check the nadir for dose effectiveness, between +5 to +7 for long acting insulins
- - the nadir should remain safely above 50 mg/dL on a human glucometer to avoid hypoglycemia

3) to monitor home intervention for slightly low numbers (if the cat is seizing, have someone drive while you give glucose/Karo).

4) to monitor high numbers to evaluate likelihood of diabetic ketoacidosis, in combination with urine or blood ketone testing. DKA is a medical emergency.

Testing:
1) Always test before giving insulin to make sure it is safe.
For now, your no shot level is 200 mg/dL on a human glucometer (230 for pet-specific); this will lower as you collect data around the middle of the cycle to know how low he is going.

2) Mid-cycle tests between shots - whenever possible, test around the nadir (lowest glucose level between shots) for your insulin, to see how low he's going. For Lantus, this often falls between +5 to +7 hours after the shot. Some folks do this on weekends or set a clock for the middle of the night to get this test done as it helps determine dose adjustments. This number should be at or above 50 mg/dL on a human glucometer (68mg/dL for pet-specific).

3) a before bed test is helpful in determining if you need to break out some higher carb food and steer the glucose level or go to bed with some peace of mind. Steering means giving 1-2 teaspoons of high carb gravy, waiting 30 minutes, and re-testing (repeating as needed) to make sure the glucose stays above 50 mg/dL.

 

thanks much for info.
Vivian is doing pretty well with injections. She doesn't mind the needle going in, and is usually calm and relatively unaware throughout the injection. But a few times she has jumped at or toward the end of the injection - and this is a tiny dose - which makes me jump and the needle comes out. My question is, why does she jump at the end of the injection? Does it sting or is it because the insulin is cold? Should I take the insulin out of the fridge an hour before the injection to warm it? Is that safe? On the occasions she has jumped and the needle has come out before all insulin was injected I have stuck it back in her and finished the injection. Not sure if this is also a no-no, she has done okay with it. I am thinking about if and when she gets a larger dose and it takes longer to complete the injection - she may be more likely to jump before the end of the injection and more insulin will be left in the syringe -
thank you
Laura

 

If it is Lantus, sometimes it stings.

hen you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

If it is Lantus, sometimes it stings.

hen you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.