Newcomer Introduction & Seeking Advice/Asking 100 Questions.

Hello, I'm Brittany, I moved to a new state and recently found a new vet. I usually only go when they need their vaccines updated or are unwell of course, I had last taken them 3 years ago.
My cat Thomas J. started having a weird scabby growth on his ear so I took him in. There was a cancer scare but after trying some medication it was going away and she said it most likely was just solar dermatitis but we'll be monitoring it. They got his lab work done and they said it all looked good but his glucose levels which were a little high but thought it was due to stress.
I gathered a urine sample for them and they called the next day saying it was +3, as in there was over 1000- 1300 ml/dl in his urine and he has to be started on insulin.
He also has a history of UTIs and kidney stones but he'd been doing well for the last 4 years being on a urinary tract health food. I've tried switching to wet food in the past and he would refuse but the last year or so he's been stealing my other cat's wet food so I'm now having success transitioning him.
I've struggled with him losing weight because he doesn't really like toys much, refusing to move and play. I've gotten him to lose a little over 2 lbs the last 6 months when I reduced his dry food and he now weighs 18 lbs.
From a few people I've been in contact with that also have diabetic cats and have treated many diabetic cats are pretty much saying that Lantus is best, ProZinc doesn't last as long, and VetSulin doesn't give good results.
He hasn't started his insulin therapy yet. The problem is that my vet is prescribing VetSulin and I'm requesting a Lantus prescription which they don't even have in house. They do have it on their online store though. They also have ProZinc but I feel like a longer lasting insulin would be best.
I haven't gotten to speak with my vet personally yet but the vet technician was adamant that she'd only prescribe me VetSulin. I asked to leave her a note about it but she said it would be best to schedule an appointment and have the discussion. Perfect, I need to have a check up on his ear anyway.
So, I'm going in Monday with him but I'm worried they'll ignore my request for the prescription and continue pressing the VetSulin. They have seemed great the last few visits but I feel like I may have to switch vets now.
Any advice?

 

Welcome to FDMB!

My first thought is that diabetes isn't typically diagnosed based on a urine test. The results are influenced by what your cat may have eaten within the last few hours. Please ask your vet to run a fructosamine test when you go in on Monday. This is a blood test that is very similar to a hemoglobin A1c that's is done for humans and gives an average of blood glucose over a period of several weeks. This will tell you definitively if your cat is diabetic versus having food or a treat spiking numbers.

Most vets do not have Lantus in house. It's a human insulin and available at a pharmacy. We encourage people to get the prescription from your vet and order from Canada. The cost is a fraction of what you'd pay in the US. Here's information on ordering from Canada.

Sigh.... You've done your homework. It's shame the vet tech hasn't. There are veterinary publications that support the use of Lantus and Prozinc for the treatment of diabetic cats. The American Animal Hospital Assn has published guidelines since 2016 that endorse the use of these two forms of insulin. This is a link to the 2018 guidelines from the AAHA.You might want to print this out and bring it with you to the vet's office. This article on which insulin in cats flat out cites the AAHA guidelines and states that Vetsulin is not recommended. FWIW, Vetsulin is also called Caninsulin outside of the US. As the name implies, it was developed for dogs. Cats are not little dogs. Their metabolism is faster and Vetsulin has less duration than Lantus or Prozinc.

I would suggest getting your cat on a low carbohydrate, canned food diet ASAP. Since you've not started insulin, the switch may tell you if it's food that's causing blood glucose numbers to be elevated. If you're able to start home testing, that would be great! You want canned food that is less than 10% carbohydrate. Many people here feed their cats Fancy Feast -- the Classic variety with is a low carb, pate style food. This is a link to a food chart where you can see the variety of canned food options that are below 10% carb.

Please let us know if you have more questions. We're happy to help!

 

Hello Brittany! Sienne and Gabby has already given you the best advice. I just stopped in to say that you rock for doing your own research and being so proactive about your furbaby's treatment. It can all be overwhelming at first, but the more knowledge you have, the better you will feel about everything. When you see your vet, be strong about wanting a better insulin. If they are stubborn, find a vet that will work with you. It's clear that Thomas J is in very good hands and he'll have a better chance at remission with you looking out for him.

 

Was tresaderm started before or after the vet diagnosed diabetes?

Is Thomas J. still on it? (it looks like he is based on your signature.)

Tresaderm has a steroid component (dexamethasone) and steroids can elevate blood glucose (BG) in some cats. So it’s possible that the tresaderm could be contributing as well. Some cats it doesn’t seem to affect, but we’ve had multiple instances on the board where owners have seen noticeable BG elevations with its use.

Often steroid-induced diabetics return to normal BG ranges after the steroids are stopped, although some do require a course of insulin. It’s especially important to home test and monitor BG in those cases as insulin requirements can change rapidly when steroids cease.

I too vote for the fructosamine.

Welcome to the board!

 

Why was Thomas J prescribed the Tresaderm? I havd used it in the past but it spiked BG by 200 or so points. If it is used for ears. there are meds with a less potent steroid if anti-inflammatory relief is needed. Otherwise there are meds that work for bacterial or fungal/yeast that do not contain steroids.

 

I agree with all that you're saying. I didn't know about this test but I'll definitely be asking for one. I already switched to the wet cat food my other cat is on which is low carb, Friskies classic Paté, but I already have plans on getting some Fancy Feast since the ingredients are a bit better and everyone recommends it. Also, I should mention that I already started home testing because I wanted to see the numbers myself. They are still in the high 200s to early 300s.

 

It was started before his diagnosis for his supposed solar dermatitis on his right ear. I also researched it and found that it basically contains steroids but didn't want to discontinue use if it might cause a flare up. I think I will stop it since it hasn't been improving his ear condition anymore anyway.

 

For treatment of the solar dermatitis on his right ear. I also suspected it of being a contributing factor to his high levels. I'm open to hearing other treatment options for his ear as well.

 

Also, thank you everybody for your replies and advice. I do truly appreciate it all.

 

His appointment has to be rescheduled due to a surgery they have that morning but I will be calling and requesting the fructosamine test.

 

The one important item missing from your signature is the insulin you are using (if any). Maybe a note to say something like "No insulin yet". Since you haven't started insulin.

Besides the AAHA Diabetes Management Guidelines Sienne and Gabby (GA) linked you to, there is also the (2015) ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

And a few years ago, 7 actually, Journal of Small Animal Practice devoted a full issue to treating Feline Diabetes. A possible opportunity to educate your vet, vet tech and vet clinic on more recent recommendations of better insulins for CATS. I don't know if this journal is available to the public. Sources I found require you to purchase even the PDF version. It was Volume 43, Issue 2 for the year 2013. Your vet my subscribe.

Merck Veterinary Manuel is used by many vets. ( Disclosure : Merck manufacturers Vetsulin so there may be a conflict of interest there.) Direct quote I found from the Merck website when I asked. "What is the best insulin for cats?"

"In newly diagnosed cats, insulin glargine is the insulin of choice. Glargine is a long-acting basal insulin. Used in conjunction with high-protein, low-carbohydrate diets, it is associated with remission of diabetes and discontinuation of insulin therapy in 80%–90% of cases within the first 3–4 mo of treatment." Bold text is not mine. Quote was exactly what you see here.

Source for that is in this link. https://www.merckvetmanual.com/endocrine-system/the-pancreas/diabetes-mellitus-in-dogs-and-cats

Hope those sources of information may convince or educate your vet on the best and most current treatments of Feline Diabetes in cats.

"The best defense is a good offense." as the saying goes. Be prepared to state your points for a different insulin when you meet with your vet office on Monday.

They may be unfamiliar with other insulins and quite reluctant to prescribe other insulins because of their inexperience. Kind of a catch22 situation. You are the advocate for your cat and need to decide what would work best for you and your cat.

Good luck! Hang in there. "Knowledge is power."

 

@Deb & Wink - She hasn't started insulin yet. The vet (tech) wants to prescribe Vetsulin vs. Brittany who want's Lantus.

 

Yes Cheryl, I know that and stated that in my reply to her. In the very first line.

 

I updated my Signature. Thank you for all the information, I'll be reading it and printing them out for my vet.

 

Hope you can convince your vet to prescribe the lantus. Hope those links help you to 'make your case' as to why Lantus is a better insulin for cats than Vetsulin.

p.s. Thanks for the signature update. Know you haven't started insulin yet, but seeing that info 'at a glance' helps us to help you quicker. When you do start insulin, update signature again. It will 'attach' that revised info to all your posts. Automatically.

 

Let me clarify something. I was not recommending that this member get Vetsulin for their cat.

I was providing additional resources for Brittany to read for some of the research that is available to vets. She can read it, and understand why Lantus is the better insulin for a cat. She can print it and either provide hard copy to her vet clinic or email it to them.

We know that vets can not keep up to date with all available research for every disease they treat for cats and dogs. Let alone try to keep up if they also have a practice that provides vet care to livestock or 'exotic' pets such as guinea pigs, rabbits, birds, snakes and other reptiles. Continuing education takes time and vets are already overburdened and burnt out in many instances.

The 'conflict of interest' I mentioned around Merck being the manufacturer of Vetsulin was because if you look up their website and read about Vetsulin, https://www.merck-animal-health-usa.com/vetsulin it looks like they are saying it's good for cats. Then they go on to say in the Merck Veterinary Manual that Lantus should be the insulin of first choice for cats. That is where the conflict of interest lies. Along with the sales reps pushing their products to vets. It may be the "First" insulin approved for cats by the FDA, but not the most recent approval of an insulin for cats.

Lots of vets prescribe many medications "off label" as do all vets that write prescriptions for Lantus and Levimer. Plus many, many other drugs for pets are prescribed without that FDA approval. "Off label" does not mean it's not a good product for cats or a bad product for cats. It may simply mean that the manufacturer has not gone through all the veterinary trials to "prove to the FDA" that their product works for animals.

Merck has sales reps, just as all the big pharmaceutical companies do for human medicine. Those sales reps for human medicine market to hospitals, pharmacy benefit managers, health insurance companies and to doctors practices. Free samples, trips to conferences, bonuses if so much of a medicine or medical device is prescribed or used by someone.

It's no different in the veterinary field. The more vets and vet clinics you convince to buy products from the company you represent, the bigger the commissions the sales reps earn. A major part of a sales reps income is from those commissions. Big incentive for the sales person to "Push" their specific companies products.

It wasn't any different in the computer industry where I worked for many years. Not as a sales rep, but as the person working for the company that came in after the sale, after the fact, independent from the company that had sold the software in the first place. We were stuck telling companies that had bought the software product, that the version they purchased did NOT have the features to run their HRMS systems they thought they were getting. In essence, the sales reps for the computer software company had 'lied, falsified, swindled' the purchasing company to "buy their product" because it was going to do such and such and it could not. The next release, available in 1 to 2 years (if it was released on time, which rarely happened) might do what the hospital or town government or utility company needed to have it do. But they had already purchased the old version of the HRMS system and signed the sales contract and they were 'stuck'. Trying to modify the product they bought to meet their needs was going to be a lot of work and EXPENSIVE. You get into big trouble if you can't pay your employees correctly and on time.

Sorry for the long digression here. Wanted to give a better explanation of what I said and my thoughts about the whole "sales reps push" to vets. Not only with insulin, but with other medications and with those "Veterinary Diet's" sold at vet offices. But that is a whole 'nother ball of wax and don't want to get into that here and now.

 

My personal experience to add is that Mimi was started on Vetsulin for the same reason your vet used, and my vet “saw good results with cats on Vetsulin”
And after only a short month went DKA (diabetic Ketoacidosis- not saying your baby will, just saying) and the first thing the emergency vet mentioned was “I never start cats on Vetsulin- that was designed more for dogs”
That vet also told me to shoot her in the flank and side of the stomach not the scruff because she was already developing a cyst from overshooting the same spot (it’s honestly so easy to shoot the same spot even though some vet-made YouTube videos will tell you to “rotate” in a clock manner to avoid that)

anyhoo, you’ve come to right place.
This page has SAVED my cat, and I’m not even worried about her going DKA because I know how to prevent it now as much as I can.
The vet told me to feed only twice a day- that’s wrong
The vet also told me the feed her a prescription diet.. please trust me when I tell you that is the biggest bunch of BS marketing. Dr Lisa Pierson is catinfo.org has a really good explanation on why it’s ridiculous.

 

I'm not sure about others but I understood what you were saying. I agree that a lot of veterinarians are misinformed about prescription pet foods believing that they're best to treat your pets while doing the opposite of that. Especially when they're being sponsored by said brands. Not all vets have time to stay up to date on different treatments and I can understand that. As well as not feeling comfortable prescribing something that they may not have worked with before. I was using a prescription dry cat food and knew it wasn't a great option for my cat but he used to refuse wet food and I didn't have many options. The better quality dry foods were even more expensive and I think that's why myself as well as others I'm sure just stuck to what was given by the vet. I'm becoming more informed on proper cat nutrition with each day I'm here and all the research I've been doing myself. Perhaps his diagnosis was a blessing in disguise.

 

Sorry I forgot I mentioned this but here’s a link
Www.catinfo.org

 

Thank you. I've actually read it already, it's very informative.

 

Here's my "100" questions.​

• I wanted to ask what's the best quality, low carb/high protein, wet cat food you would recommend? I'm going to buy some Fancy Feast but I was thinking about buying a small box of something like Tiki Cat or Weruva to see if my cats would like it. Which brands would you suggest?
  • Is one 5.5 oz can a day a good amount to feed my cat, it's only 170-180 calories, my brother thinks it's too much. From what I've read and calculated it seems good.
    • He's trying to base it off the fact Thomas J. used to eat 1/2 cup of dry food a day but I don't think that adds up the same way due to their nutritional differences.
  • Also, what brand of high carb wet foods would you recommend I put in my hypo toolbox?

• What meter would you say works the best and also cost efficient? I'm currently using my brother's (he's a type 2 diabetic) old meter, OneTouch Verio, which has maybe 50 or so test strips left and they're expensive to replace. Looking for a replacement, it's also nice to have a back up too.

• My cat has a history of kidney health problems and I was wondering what you would recommend me use to test for ketones?
  • Since I started feeding wet food my cat isn't drinking much and isn't peeing a lot. Is this good or bad? I know they usually decrease because of the high moisture content in the food but that much seems odd to me.
  • He's been peeing lakes for years though and the last few months, especially since starting his medication for his ear, tresaderm and veraflox, his drinking and urine has greatly increased. I believe these are indicators of diabetes but one does contain steroids in it.
  • He doesn't seem to be in pain and I don't notice anything bad in his urine or fecal matter. Perhaps just my anxiety?

• A few months back he started limping, couldn't tell which leg, but it went away mostly. Just comes and goes but it's very mild. His vet said she didn't notice anything abnormal when she examined him. I'm thinking perhaps this could've been another indicator of diabetes or maybe just arthritis. He is 12 years old, any supplement recommendations?

My apologies for all the questions. I have done a lot of research myself and read most of the health links/faqs here but I'm very indecisive since I'm a newbie and frankly overwhelmed. I just want to give the best care for my little turkey, Thomas J.

Any recommendations are welcomed, thank you.​

 

Update:​

Rescheduled my vet appointment to Wednesday morning due to them having a surgery this morning. The receptionist made a note of my fructosamine test request. I'm seeing the other vet though, I believe they're the one who prescribed the vetsulin. I usually see Dr.B but this time it's Dr.F who I've never met before. Wish me luck.

Hope everyone has a great week, thanks for all the help!​

 

Hi Brittany, welcome, I feed my cat Fancy Feast Classics either chicken or beef,
If you go to the
Feline Health ( Main Forum you will see Dr Pierson's food chart
It will give you names of pet foods, their carb content, protein etc
For the higher carbs I use Fancy Feast Gravy Lovers
I use 15 % for medium carbs and 20 % for higher carbs
You can look and decide what foods you want.
Also have some honey on hand
I think you are right when it comes to the calories. Tyler is also a lazy cat so I know what
you mean when it comes to losing weight.
He used to weigh 23 lbs, then 18 lbs when diagnosed, Then gained weight back ,got up to 21 lbs. He now weighs 19 lbs. He still needs to lose weight. He is a big cat but my vet would like to see him around 16 lbs at least. He doesn't play so he's not burning calories.
He's just lazy. The only time he runs is when he's chasing his brother .
I give him 2 cans of the 3 ounce Fancy Feast Classics. That's about 199 calories.
So I think you are right. Most of us feed our cats a couple times a day, not twice a day like most vets suggest. Don't feed any food 2 hours before pre shots



As for the meter most of us use the human meter Relion Prime, it's 9 dollars at Walmart and you can get the strips for 17.88 for 100 strips
I used to use a pet meter, took expensive, I love this Relion Prime meter
I hope this helps and best of luck at the vets

 

Thank you for the information. I plan on buying Fancy Feast myself. I've looked at her chart and I'm most interested in the Tiki Cat and Weruva Brands. My cats are picky eaters however and may not like the textures. Perhaps I'll try some in the future and let you guys know what they think of it. Curious to know if anyone has tried these brands before. Perhaps I'll search through the forums.
I'll check that meter out.

 

You're welcome, I do see other members feed their cats Tiki and Weruva.
You can start a separate post if you want and title it
? Anyone feed Tiki or Weruva

 

I fed my cat both the tiki cat and Weruva brands. She liked the tiki cat at first, but then she stopped liking it, which may or may not have been related to dental issues (but she is intolerant to chicken now, so the point is moot anyway ) She also liked the Weruva bff varieties I fed, but I ended up switching because I was concerned about the fact that all of them included some form of tuna. Didn’t get a chance to try any of the other lines before the food intolerance issues, but they seem like good choices based on the ingredients. What kind of kidney issues does your cat have? Do they need a food with less phosphorus?

 

He had UTI's and kidney stones about 4 years back. They had him eat urinary tract health food but obviously those aren't really considered good for cats. I haven't noticed any issues as of late thankfully as he's gotten good at drinking enough water now. I'm not able to test for ketones at the moment but I will be in the future. Perhaps less phosphorus is a good idea.

 

I believe low P is generally recommended for kidney disease, for UTIs and kidney stones I think more water is what’s recommended. Dr. Lisa Pierson who made the food chart has a lot of good info on her website about kidney health, if you haven’t already checked that out! The tiki cat does have a bit more broth than the fancy feast which would probably be good, but because it’s shredded it might be harder to mix water into it, depending on how picky about it your kitty is. For ketones, there are some blood meters that can check ketones if you didn’t already know about those and are having a hard time catching him in the box

 

Yes, I was told to make sure he drank plenty of water. Thankfully he has a fountain that helps with that, I also mix water in with some of his wet cat food. I haven't fully read the section on kidney health, I'll have to finish reading. I did see some meters had that function, I'll have to look into them some more. Thank you.

 

The ketone test meters can be expensive. It's the cost of the strips that can be high. Some folks have a regular meter for most of the daily BG testing and then use the Ketone meters to test the blood for ketones if they have a "shy peeer."

From the Health Links/FAQS forum, look in the Index sticky at the top of that forum for more helpful info.
Blood Ketone Meters

Go slow, it's a lot to digest and we don't want you anymore stressed and overwhelmed than you are.

p.s. Deb, finder of lost souls and helping redirect them to the correct forum.

 

Kidney issues and ketones are separate issues. If you're able to stalk your cat to the litter box, urinary ketone test strips (Ketostix) are fine. Otherwise, a blood ketone meter is another option.

For a cat that has kidney issues, it can help to add water to your cat's canned food. Thirst and urination tend to decrease as a diabetic cat becomes better regulated. Excess thirst and urination are symptoms of diabetes so as blood glucose numbers decrease, so does thirst and urination. The steroid medication has likely contributed to higher BG numbers hence the greater urine output.

 

I did stop using the medication since it was almost out and wasn't improving the condition of his ear anymore. I may test his blood again in a few days to see if it lowers any. Thank you for the information.

 

Thank you.

 

My Kit LOVED Tiki chicken for the 5 or so days I had her on it after diagnosis and before vet prescribed Glycobalance. I am now working on a plan to get her off Glyco and on to a low carb/ low Phosphorous FF or Tiki. Tiki has zero carb and from everything I've read there seems to be some disagreement about whether that is preferred or not. I would love to hear more from others about Tiki. It really does look and smell good enough to dive right in, even as a human! I did add some pumpkin to the Tiki.

 

That’s a really good point about the zero carbs! Here’s a link to more info about that.

http://www.felinediabetes.com/FDMB/threads/feeding-lowest-zero-carb-vs-lower-carb-foods.144220/

Weruva has two kinds that I know of that are a similar style to tiki cat, chicken frick a zee and paw lickin chicken, that are both low phosphorus and low carb. But they’re listed as only 3% and 2% carbs, so it’s possible they’re also closer to 0% as well

 

ECID Every Cat is Different. What food works well in conjunction with the particular insulin you use for your cat varies.
ECID Every Carbohydrate requirement Is Different. (Excuse me, trying to get creative here with the ECID)

You'll need to experiment with foods for your cat, to see what works for your cat. It's that darn pesky ECID again.

ESID Every Situation is Different. One size does not fit all.

Here is an example where we are going to try a higher carb food.

Helping out the owner of a kitten that uses prozinc, over in the prozinc ISG. Member is from Spain, doesn't understand much English, we are using google translate back and forth to understand each other. Not perfect, but couldn't do it without that translation. Plus we have a member from Mexico that is helping out. This Spain member has a diabetic kitten, which is rare in the first place. I've only seen a handful of diabetic kittens on the message board in the last 7 years. Her kitten (9 months) old is really close to being a diet controlled diabetic. She was feeding a very low carb food, <2%. The BG readings are not quite low enough to be considered in remission, but trying to have her give a single drop of insulin is also very difficult to do.

So she has ordered some slightly higher carb kitten food from Germany (Zooplus) and she will be trying the new food soon.

 

So, I'm a little worried about Thomas J. Since I started feeding wet food he's been acting super lazy, a lot more lazy than usual. He usually plays with his his toy pom poms a little bit during the day and typically a lot during the night. He's not playing during the day at all and barely at night. He's been increasely inactive since he started the medications a month or so ago. He's already off them now, Sunday is when he stopped the Tresaderm. I wonder if it is just due to the steroids and how long it takes to leave his system. Maybe also the diet change may be affecting his body different since it's not used to it. I was worried and checked his bg last night, I gave his ear a couple days of break since his other ear isn't fully healed so I'm only able to use one for testing. It was 321 but it had only been a little over an hour since his last feeding, I was just testing to make sure it wasn't super high and through the roof. Maybe I'm just being a bit paranoid since he's newly diagnosed but his behavior seems different to me and even my brother noticed a change this past week as well.
His appointment is tomorrow and I'm a bit nervous, I hope this other vet is nice and will listen to my thoughts and ideas. I'm open to the ProZinc but would still prefer the Lantus, definitely no VetSulin though. I know some people have luck with it but I'd rather not chance it myself.

 

Do you have your list of questions written down? That way, when you meet with the vet, you won't forget them.

Ask any human diabetic. They feel horrible when their glucose is too high. Cat's too.

 

Not too sure what questions I should ask other than why they don't want to prescribe Lantus and why they're recommending VetSulin, but I do have some answers ready if they ask why I don't want VetSulin and why I want Lantus. I've also printed out the articles and research papers on Lantus and highlighted the main points.

 

Is this one of the articles you are referring to? (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

Either hard copy or bookmark it on your smartphone works.

 

Hi there if Thomas J's ear is sore you can put Neosporin with Pain Relief Ointment on it. Make sure it's the Ointment and NOT the cream. Put a thin layer on it
Good luck tomorrow at the vets and trying to get the Lantus

 

That and a few others.

 

Thank you.

 

Alrighty, so a lot to talk about but it's good news. Went to the vet appointment, met Dr. F, he was really nice and seemed to know a quite a bit. Thomas J. was actually super calm with him compared to how erratic he usually is with Dr. B and the vet techs. It could be that he's male, my old vets were as well and he was always on good behavior with them.
So, he was trying to prescribe the VetSulin but I told him some of my thoughts and he kind of understood what I was saying. I told him I'd prefer Lantus or ProZinc secondly because of their long duration and high remission rates. He said he'd have to look it all up to know for sure and I let him see some of my research. He actually forgot Lantus was glargine, he thought it was something else and then said he'd write a prescription for me to see if I could get it for cheaper since their store is super expensive, as well as the syringes. He was saying they don't work with many diabetic animals, usually just dogs with very, very few cats.
He also mentioned like a continuous glucose monitor like what humans have, where it measures the blood every 15 minutes, he said he hadn't used it himself but many of his colleagues have good experience with them. I said I'd do some research on it but was interested. Also, we were talking about testing and asked if we could bring in our meter to compare and see if it's a good option to measure his bg.
He was talking about regulating with a prescription diet with high fiber and in my head I was like, heck no. I told him I switched him to wet food already that it was low carbs and he's doing well with it. He said he thinks his ideal weight is about 13 lbs and that 200 calories and under like what I'm feeding him sounded good. I was concerned about his weight because he's lost nearly a pound the last week since switching and I was worried. He said with diabetic animals it's common for them to drop a lot in the beginning when switching foods. He was 17.6 lb last week, this week 16.8 lb.
We're going back on the Veraflox, the oral medication that has no steroids to see it that works better rather than the Tresaderm because he agreed it was probably causing higher bg.
We talked about the fructosamine test and he said he wouldn't do the test until he's on insulin so he can see all his levels and how it's working for him.
So, we went to our local pharmacy where my brother goes to check prices. They said for the vial of Lantus the lowest was $229.68 which isn't horrible compared to the $350 at the vet. Also, they said they had the generic Basaglar 300 unit pen for $72 but the prescription was for the 10 ml vial so we have to check with the vet first. She said it was cheaper at Walmart and to give them a call to check. Haven't figured out the price for the syringes but I'll figure it out soon.

So, basically, what are your thoughts on Basaglar?

 

Basaglar is a bio-similar to Lantus insulin. Similar to, but not the same as glargine/lantus. Don't know anything about it beyond that.

10 ml vial has 1000 units, but sometimes loses it's efficacy before you use it all up.
3 ml pen or 300 units, can usually use to the last drop

Roughly 2 months at 2U twice a day for the pens (2u may be more than you need to give)
Roughly 4 months at 2U twice a day if figure only can use half before you need to toss the vial

Calculate your per unit cost and what the difference would be if you had to throw out the 10ml vial after a couple of months.

Lantus also available in 3 ml minivial - Lantus Solostar pen. Use insulin syringe to withdraw the insulin. Need to do this so we can draw out those tiny doses our kitties need.

I'd go with a pen. Then when you need more, order from Mark's Marine Pharmacy in Canada. Lots of members here do that. Call first, because they may still have an order backup. https://www.facebook.com/canshipmeds/
Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies

Maybe read this thread for a member recently asking about pen vs vial.

Switching from Novolin to Glargine; Do I shoot with the same amount of units as I did with Novolin?

https://www.drugs.com/medical-answers/difference-between-basaglar-lantus-3016716/
https://www.goodrx.com/blog/lantus-vs-basaglar-effectiveness-dosing-side-effects-cost/

 

I believe that Chris used basaglar for her kitty

@Chris & China (GA)

 

I'll chime in with the caveat that I'm a total newbie myself, but Brittany reminds me of me, with 1000 questions and a great sense of urgency. I totally get it.

I would recommend sticking to your guns regarding the Lantus. Insist on it - your vet will listen. Start with the Lantus pen - it's usually less than $100 USD, and I've found it quite easy to use. I'm surprised your vet wouldn't test for fructosamine until *after* starting insulin... that seems backward to me.

Also... the first indication that something was wrong with my Edward was an inexplicable limp. It took visits to 2 vets before blood tests revealed high BG and fructosamine. The limp subsided on its own, although his rear legs still aren't as strong as they used to be, which is why I started him on Zobaline, which is a methylcobalamin B12 vitamin specifically formulated to help treat/reverse diabetic neuropathy in cats. You might consider adding it to Thomas J's food once a day.

Anyway, you have found the right place! Best of luck to you and Thomas J on your journey.

 

Alright, so the pharmacist called back and I asked her what the Lantus pen cost and guess what, turns out they're cheaper than the Basaglar. 1 Lantus pen was $69.45 and the Basaglar was $72. A 5 pack was $337 which I didn't have a prescription for anyway. So, I bought the 1 Lantus pen and $36.52 for his syringes. I only had to pay $106 altogether. I have a refill too so in 2- 3 month I can have it refilled and hopefully the price doesn't jump up too much. I'm very thankful for my local Walgreen's pharmacy. The vet said to give him 1 unit once a day and showed me where and how at the appointment. Will start in the morning, gonna read over everything again to make sure I do it correctly. Wish me luck.
Thank you everyone for your advice!

 

Good luck!

Keeping your SS updated helps us to follow along.
Do you know when to test when you are first starting Lantus?
Have you decided which dosing protocol you are going to start with?
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

 

That is expensive if they are not BD syringes. None BD syrines are typically a lot less expensive.
https://www.adwdiabetes.com/categor...t-by-field=BESTMATCH,page=1,ppp=20,op=fs,ps=|

 

Hi Brittany just trying to help
there is a supply closet here that members sell insulin when their kitties have passed. I see right now there is some one selling the Lantus Pens for 30.00 each plus shipping. One pen can last 6 months depending on the dose you are giving. I myself have bought Lantus pens from the supply closet, If you are interested I can give you her name
Also if you do get an extra pen and the expiration date might day 2021 or 2022 that means they are good until then as long as you don't use them, leave them in the fridge
Also next time you need U-100 syringes order them from ADW Diabetes
they are so much cheaper
Did the pharmacy sell you the syringes with half unit markings, makes it easier if you ever had to decrease or increase by 0.25 units

Just to show you what I use, but they have other brands just as cheap
I just prefer the longer needle they also have a coupon code save 10% its DIA10
And these have half unit markings

Monoject Ultra Comfort U-100 Insulin Syringes 29G 3/10cc 1/2" 100/bx
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Product Description

Monoject Ultra Comfort U-100 Insulin Syringes 29 Gauge 3/10cc 1/2 inch (12.7 mm) 100 single use syringes. These syringes include Half unit markings for precise dosing for 30 units or less. Every Monoject Ultra Comfort Insulin Syringe has been engineered to provide you with unparalleled comfort, accuracy and ease

 

They are BD and I just realized they don't have half unit markings. I didn't notice at the pharmacy even when she opened a bag to show me. I'm an idiot, I knew what size to get and still didn't get the correct ones. I'll have to get new ones now. Also, the vet said 1 unit once a day but won't it wear off by the time 24 hours have elapsed? Shouldn't it be every 12 hours but 1 unit would probably be too much twice, so would it be 1/2 unit twice a day? I should've asked these questions at my vet, I'll have to call tomorrow and see if Dr. F is even in to ask.

 

Yeah, I shouldn't have tried getting stuff done all at once. It would've been better to get the syringes cheaper elsewhere. Do I have to have a prescription to buy the syringes? Not sure if I should buy another pen right now or not.

 

Hi Brittany you would just call ADW diabetes and tell them which syringes you want and they will ask you for your vets name and phone # and they will contact them by fax and just get the ok then you can order them and ask your vet for refills and then you can just go on line and order them. That's what I did, ADW is so nice to deal with and never had a problem with them at all.
Just suggesting for the price that the member is selling them for I would pick up another one, just leave it in the fridge. They say to put them in the middle of a shelf not on the inside of the door. If you want her name let me know and I will direct you to her. I just asked her 2 days ago and she has 4 of them. If you decide to get one she might be a little slow getting back to you, she told me she is in the middle of moving, but she will get back to you. She packs them with an ice pack so not to worry about shipping them. The expiration is exp is 04-30-2022 I asked her

 

Hey Brittany you are not an idiot,, how would you know , can you bring them back to the pharmacy and see if they have half unit markings, if not ask for your money back
Yes Lantus is usually given every 12 hours, I think 1 unit twice a day is too much to start with, I am going to tag a few members for you to see what they think, starting with 0.5 units every 12 hours sounds about right, let me tag members right now hang in there someone should answer

 

@Bron and Sheba (GA)
@Deb & Wink
Hi Bron and Deb can you please take a look at what Brittany has posted Thank you
I'm trying to help her out

 

Thank you for the information on the website. I'll have to think about getting another pen a bit more but I agree that a back up would be a good idea and I'd already have an extra for when I run out. I saw the purple box that had half units there but it's like my mind went blank when I actually went up to pay. She opened a bag to show the syringe so I can't get a refund but it's not a big deal, I'll just have them for if the dose gets increased.

 

Yeah you can put them away if you ever have to give full doses, it's just easier to eye ball 0.25 if you ever have to decrease the dose, or increase.
For example not that you need to know this right now
If you ever get down to giving 0.25 units you would bring the stopper of the syringe between the zero line and the 0.5 line, you would eye ball it the best you can
I just want to make sure they were U-100 syringes correct
Brittany I see you said you said you are using your brothers meter and that the strips are too expensive and had some left. If you do plan on buying another meter just make sure you put the new one in your signature .I assume you will be using a human meter since you were asking for suggestions in one of your posts and I see Bron posted something since I tagged her , just a heads up @LilTurkey

 

Lantus needs to be given twice a day.
You probably haven't thought about what dosing method you are going to use....you can check that out when you are ready .....but if we say you are doing the SLGS method...start low go slow method......because you have swapped over to low carb wet diet, you will start off with 1/2 unit twice a day and hold that dose for 7 days, unless Thomas drops below 50 in which case you would reduce the dose. Then do a curve after 7days.
Make sure you test before EVERY SHOT and try and get some inbetween tests in as well around the +3 to +7 timeframe.
The routine is test, feed, give the insulin in that order.
If you get a Preshot number under 200....stall, don't feed, post and ask for advice and test again in 20 mins.

I would also test daily for ketones at the moment while you are starting off with insulin as a precaution..

 

@Bron and Sheba (GA) hi Bron would you mind taking a look at #56
I'm trying to help out Brittany about dosing
Thank you

 

Thank you Bron , I didn't want to give her any wrong info, but I figured 0.5 units to start with was correct thanks again

 

Pleasure....you have been giving Brittany and Thomas lots of good info...there is so much in the beginning

 

I'm trying Bron, I have learned so much, but not when it comes to dosing.
Linda MrWorfMen's Mom has taught me well, just trying to help others, like they have helped me with the little bit I do know @Bron and Sheba (GA)

 

Yes I did. I volunteered to test it on China when it first came out because, well....someone had to! China was so tightly regulated that most people thought I was nuts for trying it (why mess with something that's obviously working??) but I figured that because she WAS so tightly controlled, if the Basaglar was going to act differently, we'd know it.

Once the depot was established, she reacted exactly the same as on the Lantus

 

Thank you. Yes, they are U- 100. No worries, I will keep it up to date to the best of my abilities. I will insert a picture.

 

Thanks so much for the advice. I need to buy some of those ketone testing strips. I'll see if I can buy the correct syringes tomorrow. I will dose as suggested, 0.5 unit every 12 hours, and keep an eye on him by testing. Seems like every 3 or 4 hours I should check or more frequently? I need to read up some more on everything. I'm trying to get him into remission so TR I think?

 

Unfortunately, those aren't really going to work well at all....For one thing, they're 1ml syringes which hold 100 units, so each mark on the syringe is probably 2U.

All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

 

I know they're incorrect, just showing the specific kind I have. Getting correct ones soon. Thank you, didn't know they sold those there. I should check them out.

 

Yes, 1ml insulin syringes are only markede every 2 units. That is OK for high doeses but not goo for low doses like starting at 1 unit.

 

Third opinion on those 1ml syringes. Horrible to try and measure tiny doses for our cats. It's what the shelter gave me for my foster Wink. Learned that the 3/10cc volume syringes were the right ones. Made it a bit easier. Then I convinced the shelter to have their vet write a prescription and send it to my closest Wal-mart which is in NH. Where I did pick up the Relion syringes with 1/2 unit markings on the barrel.

Every state is different in weather they require a prescription for insulin syringes.

 

Yeah, I definitely don't trust myself trying to do some kind of guesstimate with these ones. Rather have the corrects ones and be accurate. I may have to just buy more expensive ones out of convenience at the moment to get him started sooner. I don't have my own vehicle so I'm carpooling with my brother and have to work with his schedule to drive to places. I do go grocery shopping Saturday at our local Walmart, if I have to get another prescription then I could pick them up that day. If they just let me buy them today though, I'll just grab the more expensive ones and pick up some cheaper ones next time at the online store you guys reccomend.

 

If you are starting the Lantus tomorrow (well guess it's already that now since I'm up early posting) so I mean Thursday 1/30/2020.

Testing times with TR should be Pre-shot, +3, +6, +9 for each 12 hour cycle. Yes, Lantus is best dosed twice a day. 0.5U is a nice low starting dose.

Suggest you print a copy of the
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) protocol for Lantus. NOT to be used with OTHER insulins. Here is an excerpt:
"Kitty should be monitored closely the first three days when starting Lantus or Levemir. Initially, blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed." from the Lantus TR protocol. More may be needed. You need the "depot" storage area to fill first, to see the full effect of the dose you are giving.

Don't try to rush things. We know you want to get your kitty feeling better quickly, but feline diabetes is not something that happened quickly and it takes time to treat it properly.

 

I can't start it today anymore because I don't have the right syringes and I don't want to start it during the night because I can't properly monitor him if I'm sleeping. I'll start at morning time whenever I have the right supplies. Thanks for the info. I'll read it over again a few times.

 

Went back to the pharmacy, they had the 3/10cc kind but not the half markings kind so they ordered them for me. I triple checked to make sure they were the right ones. I'll just be doing an exchange on my others. I didn't think they'd allow me to return them but they do. They should be in tomorrow. I will buy more cost efficient ones in the future though. Thanks everyone for all of your help! I was feeling stressed but you all made it a whole lot easier.

 

Sienne and Gabby (GA) has suggested that there are many more experienced users of Lantus on the Lantus ISG. You may want to think about posting over there.
Lantus / Basaglar (glargine) and Levemir (detemir)

 

Alrighty. I'll start posting over there. Thank you.

 

You've got the basics. You'll do great over there!!!

Read the first sticky at the top on how to post there. They are particular about the format of the title in you post. Helps them see if anyone is having an issue that needs to be addressed and prioritized.

 

Hey Brittany here is how you post on the lantus board
Daily Threads & Posting Instructions for this forum:

• Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
• Start your thread with the date, kitty's name, and AMPS
• Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
• The 911 prefix in the subject line should only be used for emergencies such as symptomatic hypos, very low numbers (below 30 on a human meter), and/or very sick cats potentially needing ER care. Please remove the 911 as soon as someone has responded and you have received help.
• 
  
• Go take a look at mine if you want to
• You post a new thread for every day
• Here is an example , just an example
• 
  
• 2-1-20 Thomas J AMPS- then put his pre shot number then when you test such as 92@+3/86@+6 etc/ PMPS do the same thing when you have to add to it when you test him you will see this on the right hand side it says
• Thread Tools tap on that it will say edit title tap on that and add your tests in the blaclk area and add his BG and hit save
  
• Before you start the new thread for the next day you will go to the top of your post that you did on 2-1-20 or whatever date you start the lantus and copy the URL for that day its all the way at the top of your page you will see it say www.feline diabetes.com/FDMB/threads and the date and paste it so that if members want to see what you did before that can just tap on it, you will do that for every new day
• 
  
• Now for the next day you would go to the lantus board and to the right it will say start a new thread, hit that and do the same thing example
• 2-2-20 Thomas J AMPS etc
• You can post any questions you might have

 

A little confusing but I think I know what you're saying. When I need to post make sure I put that information in the title. Copy the url for the day and put it in my next thread for the next day? Do I have to put every one of them? Should I put this post's url in my new one too? I'll have a look at some other people's and I think it'll give me the right idea. I'll reread that too. Thank you.

 

Hey Brittany When you do your first post in the lantus forum put the date, cats name, then AMPS
Then you can write underneath that you can day you are Brittany and just started langue, or any thing else you want to say
Then if you test him through the day just just tap on where it says thread tools and edit and put your test numbers in there and hit save, then when you test him at night put PMPS and do the same

Now the next day go back to the day before and copy what's way at the top of that page you will see it says www.felinediabetes.com/FDMB/threads and the date
Now you will start a new thread, date, cats name AMPS
Then paste what you copied underneath that which will be what you wrote the day before and put any questions you may have or whatever you might want to write
Its so if members want to see the info from the day before they can just tap on that and it brings them your info from the day before, sorry if I'm confusing you, I was confused when I started. Go and look at mine from today's date 1-30-2020 and you will see it in blue, if you tap on it it will show you my info from 1-29-2020
I'll try and help you when it's your first and second post ok
Your title is the date, cats name and his AMPS (AM pre shot)
Underneath goes the URL info from the day before , not every thing you wrote from the day before, take a look at mine from the date I posted above

 

Brittany did you get some ketostix from the pharmacy? If you aren’t starting the insulin yet, I would definitely test the urine for ketones as a precaution.

Also when you have time check out the two dosing methods on the top of the Lantus page and chose one to follow... not urgent but once you’ve chosen one you can follow the method.

 

You could practice doing one here.

Change your thread title to how they like seeing the information over in the Lantus ISG I mean.

 

Hey Deb good idea

 

I haven't started insulin yet, waiting to get the correct syringes. Do I have to have a prescription for ketostix? I haven't gotten them yet.

 

No prescription needed for ketone test strips. Look in the diabetic supplies section at your local drugstore or at Wal-mart.

 

Thank you. I will check.

 

Do you know if the ReliOn Ketone Test Strips work the same?

 

Do you mean the same as Ketostix....if so yes.

 

Ketostix is simply a brand name for ketone test strips. Any type of ketone test strips will work the same way.

Ready for some ideas in getting a fresh urine sample to use with the ketone test strips? This may help you out.

Ideas for catching a urine sample.

 

Not sure about this and maybe someone else here would know more but the Weruva and tiki cat are very high in protein. I started out feeding to my cat in the beginning and several months later they told me his kidney values were up so not sure if the high protein was taxing or... I switched him to food that was moderate protein but still lower carb and 2.5 yrs later they told me his kidney values were better then than they were at the time they said he had early stage kidney failure. Not sure if available to you but I had very good luck with Whole Earth Farms duck pate and chicken pate and Organix turkey pate and chicken pate. Also Wellness Healthy Choices I think it was turkey.

 

Lilturkey has moved to the ISG for her specific insulin. Getting food suggestions there too!