Boogey's Sugarmomma

Hi, my 13 yr old, 12 pound furbaby was diagnosed on Monday his diabetes. Thankful we have no ketone issues at this time. Many tears and many dollars later I am here for the community support and knowledge. Boogey use to be a free range dry food eater with occasional wet food. We are transitioning to scheduled wet food only and it's going well. My only problem is he has only eaten one flavor of wet food his entire life and it's a FF salmon & ocean fish which thankful is below 10 on the carb charts, but any suggestions on expanding his pallet, I'm willing to listen. He is getting 2 units of Lantus every 12 hours and surprisingly the shots are easy. My biggest concern is the cost in keeping this going. My vet prescribed human insulin 100 units and it was $275 and according to my calculator that covers 25 days. If my vet decides to increase his dose I just can't afford it. I tried to set up a pharmaceutical coupon but they refused to active it since it's for a cat which at $100 off I was really ticked off. How do I get the insulin for less?? I also called every single pharmacy $260 was the lowest. Also I've purchased the Relion glucose tester from Walmart but haven't tried it yet. I need to watch videos and work my way up to this part. Its all so much to take in. I'm due for a vet visit next Tuesday. Overall, his personality is happier just after a couple days on insulin and the excessive drinking has stopped. Any tip/knowledge you can pass on are greatly appreciated. Thank you, Tiffany

 

Welcome Tiffany!

Believe me, we were all in your shoes when we we first started out. But things WILL get easier as you absorb more knowledge. It's all very overwhelming at first, but you take it one step at a time and you'll do great.

I'm going to answer your questions here (sorry for the long post!), but the best place to get answers to any sort of questions you have is the Health Forum. There's a ton of experienced folks there that can help you out with any questions you can think of!

First, food. You can feed any canned food that's less than 10% carbs, and there's a great list here of all the commercial foods with their carb content listed. I would just buy a bunch of cans of different flavored Fancy Feast or Sheba pates and see if any appeal to him. You can try mixing his FF salmon in with it and see if that works? Or Fortiflora also helps get cats onto new foods because it has the same flavorings dry food has to get cats to eat it (and can help prevent digestive upset from the new food). You just mix it in with the canned food. You can also try mixing tuna or tuna water in with the food. And feeding more frequently (4 times a day or more) also helps because he can eat smaller portions at a time--this is especially helpful if he's a cat that takes a few bites and then walks away.

I definitely hear you on the Lantus sticker shock! When Bandit was diagnosed back in 2009, Lantus was $110 for a vial and $250 for a box of 5 pens (the pens are more economical, and I'll explain that in a minute). I remember thinking that was expensive at the time! When he needed to go back on insulin for a short time last year, I wasn't worried about the cost at first because I make a bit more money now than I did in 2009, but then I priced it at a few different pharmacies and I was shocked to find the price had risen to $270 for a vial and over $500 for a box of pens!

Fortunately, I came back here to FDMB and discovered that you can order Lantus from Canada from this website for a fraction of the cost. All you need is the script from your vet, and you can either scan it or fax it in to the company. It does take between 1-3 weeks to reach you, so make sure you give enough lead time to order--typically it takes a week, but on rare occasions it can get stuck at customs and take a little more time.

The best bargain is to order the 5 pack of the Lantus solostar pens. You draw the insulin out of the pen with a syringe just like a vial. It costs about $170 after shipping, but each pen, when handled properly, will last you 2-3 months, so the 5 pack of pens will last you a year or more. That breaks down to being less than $15 a month for insulin. Because cats need very small doses of insulin, you end up throwing away most of the 1000 unit vial because it goes bad before you can use most of it. The pens each hold 300 units, so you can use nearly all of it up without any waste.

Even though the pharmacy says the Lantus only lasts 28 days, that is only accurate when it's left out at room temperature. Lantus can actually last 3-6 months with good handling. You'll want to keep it in the refrigerator where it won't get jostled around (not in the door), and when you're drawing insulin out of the vial or pen, make sure that you shoot the excess insulin into the sink and not back into the vial--the lubricant from the syringes will shorten the life of your insulin if it gets back into your supply.

How much does Boogey weigh? Is he overweight/underweight? 2u is a bit high for a starting dose for a cat unless he's a large framed cat, like a Maine Coon. I would definitely start home testing as soon as you feel like you're ready to start. It's the best thing you can do to not only keep your cat safe, but also get him better! Daily home testing gives you better control over blood sugar, and the better control you have the more likely it is for your cat to go into remission.

Don't be afraid of home testing. Some cats struggle at first and some cats don't mind it at all. Those that struggle (Bandit was just awful the first two weeks!) will come around and accept it, but you need to make it part of their routine. Make sure you're confident and not thinking, "Oh, poor kitty!". Cats can sense your nervousness and will act nervous, too. Be matter of fact about it, and make sure you give a diabetic safe treat after every test. The testing does not hurt them at all--cats have less nerve endings in their ears than people do in their fingers. They just don't like that you're doing something new and strange with them. There's a lot of great tips here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/. Bandit now comes running when he hears the meter beep on, and sits patiently and purrs through the test.

 

I forgot to mention up above, a vial of Lantus is 1000 units, not 100. Each pen is 300 units. Either your vet accidentally left off a zero or the handwriting was bad, but there are no 100 unit vials of Lantus.

 

My kitty was 13 pounds and is now down to 12 pounds. He is a bigger framed cat. My vet has not really specified if he is over weight, but definitely pushed the diet change immediately. I'm assuming he is a little bit overweight, but he is so fluffy its hard to tell from a non-expert furbaby mama point of view.

According to the range on the vet's blood test, his glucose was so high it wasn't on the range on his paper. I'm guessing that's why he started at 2 units??

I will have to check my vial when I get home. I really thought both the prescription and bottle said 100, but 1000 would mean it last soooooo much longer. I could cry because that would actually be financially do-able!!!! The vet advised how the vial last longer in the than 28 days and not to worry and I thought it was weird that he said that given that it was only 100 units (100/4 being 25 days worth). This is all making more sense now. Do you hold the vial upside when you draw the insulin out? The Vet Tech told me to pull the plunger out on the needle, then insert the needle and push the air in and pull out what I need. I was doing this with the insulin bottle upside, but I don't think that's correct.

I will definitely plan in advance and order from Canada next time. Thank you for the info!

This weekend I will be reading up and starting the attempts for at home testing. I bought the Relion test, but the store was stripped clean of the test strips. Which ones do you recommend? I also bought the lance or lancet?? but I'm assuming I need to buy tips?? Do I use a new tip every time? I don't know how these things work.

I'm so thankfully for everyone that monitors and upkeeps this forum/website. It has taken a lot of the fear and anxiety out of this process. I'm amazed at how little information the vet gave me compared to reading on this site. I fully believe in being 100% informed. Thank you for your time and dedication.

 

Yes, the bottle does say 100, but it says U100. That is the strength; 100 units per ml. So in the 10 ml vial, the vial contains 1000 units.
Pet-only insulins like ProZinc and Vetsulin/Caninsulin are U40; 40 units per ml.

 

If he's a little overweight, then his starting dose should have been 1 unit of Lantus. If he isn't overweight at 12 lbs, then his starting dose of Lantus should have been 1.25u, not 2u. The starting dose for Lantus is .25u per kg of ideal weight, unless the cat is underweight and then it's .25u per kg of actual weight. Either way, the vet started you a little too high with the dose. It's important not to overdose cats in the beginning, because too much insulin can look just like too little insulin if you're not home testing. If you changed him to a low carb, canned diet already, I would strongly urge you to start home testing immediately, or to drop the dose down to 1u. It does not matter how high your cat's blood sugar was at diagnosis, a little insulin goes a very long way with cats. Bandit is 11.5 lbs (he was a little overweight at 12.5 lbs when he was diagnosed), and he's never needed more than 1.5u at any point in time (including when he was on steroids)! Starting him at 2u could have caused a dangerous hypoglycemic incident. Unfortunately, some vets can be very good in prescribing the right insulin, and getting you on the right food, and encourage you to home test just like your vet did--and then not really understand how to correctly dose Lantus in cats. I went through this exact issue with the vet who diagnosed Bandit. She got everything right except how to adjust the Lantus dose--and if I had listened to her dosing advice instead of the advice from the very experienced folks over in the Lantus Forum, I would have have made some dangerous dose increases that could have harmed Bandit.

With the exception of the very first vial we bought back in 2009, I've always used the pens instead of the vial, and you definitely don't want to inject air into the pens. This will shorten the life of the Lantus. I think it's ok to do with the vial, however, as long as you're not injecting the excess insulin that you're drawing into the syringe back into the vial. Here's information on how to properly store and handle the Lantus: http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

Many people use the Relion meters here, because the strips are inexpensive and easy find! Which model Relion did you buy? You can also buy strips for it online through the American Diabetes Warehouse, but it has a different name there--the arkray glucocard (sp?), I think? I would call Walmart and ask when they expect their strips back in stock, so you can get them and start testing ASAP. I like to use the Relion lancet device, but many people would rather free hand the poke with the just the lancets (what you're calling the tips). Pick up the "Thin" 26-28g lancets--if you get lancets that are too small (30-33g), it's very hard to get a big enough drop of blood for the test. Yes, you need to use a new lancet for each poke, but they're really cheap, so I wouldn't worry about the cost of those.

It's more common than not that vets just don't have all the information they should about feline diabetes. It's understandable--they need to know a lot about many different diseases for many different animals, so it's hard to get every detail of these right. Everyone here is dealing with feline diabetes every day, and we can focus completely on just that disease. You're actually in a much better position than most people who arrive here, so I wouldn't be too hard on your vet! Many people show up here with the wrong insulin for cats, a dry, high carb diet, having been told by their vets not to home test because it's not necessary or their cats will hate them. Your vet seems to have everything pretty spot on except the dosing, and we can definitely help you with that! Once you're home testing and get some good input from the Lantus folks on dosing, we can give you information to print and bring back to your vet on how the dose should be adjusted, if they take issue with you going against their advice.

 

Also, just to double check (because my old vet certainly got this wrong), you are giving insulin twice a day, correct? Every 12 hours?

 

Yes every 12 hours. I will definitely be lowering the dose this evening. The hypo- reactions are a huge fear of mine. Given this dosage info I will go the next town over for testing supplies to start testing ASAP.

My insulin dose say U100. That is such a relief!!!! 1000 units YAYYYYYYY!

The more we know the more we grow. Thank you again for the shared wisdom.

 

This is great! Make sure you come back and post in the Health Forum when you start testing--we can give you advice if you're having trouble, and help you set up a spreadsheet so you can get dosing advice from the more experienced members using Lantus.

 

A pharmacist may say the insulin is good only for 28 days - but that is all it was tested it for. Keeping it refrigerated on a stationary shelf and many of our users have used it successfully for up to 6 months.