Sticker shock

My cat is currently getting 8 units of ProZinc b.i.d., and his symptoms are no better than they were on 7, 6, 5, 4, etc. In fact, they're no better than they were before he was diagnosed. Polydipsia, polyuria, BG ranging mostly between 300 and 400, sometimes higher, and a few times lower. For a time last winter, he seemed fairly stable on 2 or 2.5 units and his fructosamine tests were in the normal range (this was before I started home-testing), but that didn't last, and the dose has been going up and up and up. Meanwhile, my vet hasn't returned my last two calls telling him that 8 units hasn't improved anything.

I would like to change insulin to see if that would help any. If my vet continues to be unavailable, I'm going to have to start over with a new vet, and it's going to cost me around $300 for an office visit, BG curve, and probably urinalysis--which I can't really afford right now, so I probably won't be able to pay for testing for anything else for at least a couple of months. I'll try changing insulin first if at all possible.

I was shocked to read some of the amounts some of you seem to be giving your high-dose cats. I never knew it could go that high, and I certainly could never afford some of those doses--not with ProZinc, anyway. Since I want to change insulin anyway, I'm looking for one that's less expensive. I'm paying $125 for a 10 mL bottle of ProZinc, and at 16 units/day, we're burning through it frighteningly fast. I've spent a fortune on testing, office visits, and supplies in the past 8 months, on top of treating another cat's cancer before that, and the money barrel is almost scraped dry. But I'm willing to try another dose increase or two before I give up entirely, if I can find an insulin that I can afford. So are there any insulins that would be significantly cheaper than the ProZinc?

 

Insulins do seem to b cheaper in Canada - I've seen that some people order on line and have it shipped. I think that Prozinc is a U40, and Lantus and Levemir are both U100, so in theory at least, you would use less because they are stronger. I say 'in theory' because if he has an underlying condition like acromegaly he may just need more insulin to achieve somewhat normalized bg numbers.

Given that he does seem to be a high dose cat, I would suggest changing to Levemir. If he were to go to perhaps 6 units bid, a 10 ml bottle would last 166 shots or 83 days. This might be stretching the life of a vial a bit, and so it might be more economical to get the cartridges - there are 5 3ml cartridges in a box. They cost a little more than a vial, but you get a little more and you can usually use each one to the last drop. B/c you only handle one at a time, the others do not start to 'age' until you take them out of the box and start withdrawing from them. You use u100 syringes, so the cost there is the same.

I'm not sure what else to tell you. If you have other specific questions, ask away.

 

I think it's a very good idea to switch to an insulin such as Lantus or better yet, Levemir. I am biased because my two acros are quite well regulated on Levemir. I can't comment on the costs of the various insulins, but many go order online from Canada for the better prices.

While you may be spending on insulin still, you can find plenty of ways to save by cutting out the expensive fructosamine tests... they are just an average of the last few weeks, but if you are home testing, you already know much better how your cat is doing! There is no need for curves at the vet or any visits at all unless your cat is sick.

About the doses that some acros are at - some are higher and some are lower, and it changes as the hormone output changes. Just think of a faucet - it could be dripping or it could be running. One of my acros, Shadoe has been as low as 2.5u and as high as 17u BID. Right now she has been dropping and is at 13.5u today. I don't consult my vet for any issues relating to acromegaly or dosing at all.

If your expenses are just your insulin, the syringes and some test strips, you will see a big decrease in the damages to your wallet!

You can get help to put your test numbers into a google spreadsheet as it's the main tool that will be critical for you to see how your cat is doing and it will make the data available to others so that they can help you with dosing and other assistance.

Before switching vets, just go into the office and tell your vet you want to switch to levemir, or to Lantus. Get the rx and some U100 syringes and save yourself the expense of a new vet tests. If your cat is not sick, why have expensive testing done on urine and blood?

I keep copies of all paperwork and test results from our vet visits, so you should ask for copies of your cat's records when you go about the rx for another insulin. Just say that you want a copy of all to keep in a binder.... you paid for the tests, so you are entitled to copies of the results.

Once you switch insulins, you may be pleasantly surprised and see your cat's dose be lower and more level than with the current insulin.

 

I switched from prozinc to levemir in february for the same reason as you. Charlie was up to 13 (?) units bid of pz and still not regulated. No way could I afford that. So we switched to lev and tested for acromegaly (positive). I agree. No need to test for anything right away. The insulin switch is enough. If you wanted to run a blood panel, or test for high-dose conditions, it can wait. You can also figure out dosing yourself and do your own curves. No need to pay a vet for it. I just use a vet for my rx, although I'm probably going to need him for more in the future as acro causes other issues that may require medication at some point. But I dose by myself (with the help of the other wonderful acro beans). If you switch insulin you will want to start at a reduced dose. AT LeAST half of what he is on with prozinc. Maybe lower. I started with a half dose but that is because we strongly suspected the acromegaly and I didn't want to start over and keep him at high numbers longer than necessary. Some people start over at 1u, though. It's about your comfort level and the state of your kitty. Definitely switch to an L insulin, though!

 

I haven't paid for testing at the vet or office visits since I started home testing, except for a blood panel in May. On Friday, I refused to take him in for a fructosamine test done that I was "scheduled" for (i.e., they had it in their computer that I was supposed to get it), since it wasn't going to provide any new information. On the phone, my vet was not at all receptive to changing insulin until we get to one unit per pound of body weight (12, in this case) on the ProZinc. And he raised the dose to 9 units, which so far hasn't made any difference (he's been on it four days). I'm not going to raise it any further, and I'll try again to switch insulin once this bottle of ProZinc is nearly gone.

I already pay only for insulin, syringes, test strips, lancets, and pee sticks to test for ketones, and I already can't afford this level of treatment.

 

Could it be that the vet will lose out on money if you get your insulin and supplies elsewhere?
Prozinc is not long lasting enough for any insulin resistance, so tell the vet that you want to try a longer lasting insulin and does he have one? Oh, you don't? Well, then, let's try Levemir or Lantus!

You hometest, yes? Maybe if you were to do some curves, testing every 2hrs for a few cycles, the vet will see what is happening with this insulin and see also when it is fizzling. Can you set up a spreadsheet that most people on this site use for tracking their BG test numbers and doses - it will help to prove to your vet what is going on, and it will provide the info to those on this site so that they can give you their suggestions.

I wonder if you should start to look into consulting a few other vets. You don't need to switch, but you CAN ask some questions, and get a feel for the other vets. I have recently changed vets, and one of the questions I asked was "what insulin do you rx for your diabetic clients?" My old vet said caninsulin, and knew nothing about lantus or lev; the new vet immediately said lantus and never caninsulin. I made a list of about a dozen questions that concerned me with my two acros, and I was quite pleased.

There are so many things that we can easily do on our own at home, cutting out lots of expense, so all you need is a vet who will work with you and listen to new things and consider what you bring to the table. I took info on levemir to my new vet, and on our next visit, he said he looked it up and thanked me because he found my info was current and correct. That's the kind of vet you want, not one with little flexibility.

 

What dose is Charlie on now?

 

You can see the link to Charlie's SS in her signature.... just click on the link and you can see how Claudia's been tracking his BG tests.

The spreadsheet is an excellent tool so have a look and see what you think.

 

We were up to 9u bid, but got some scary-low numbers, so I dropped him way back to 4u bid and worked my way back up. We're up to 8.75 right now. I'm hoping to see something hood cuz I'm a little scared to try 9 again!

 

just looked back at my own spreadsheet. Charlie was actually at 8.75u of prozinc when we switched to levemir.

 

Wishing you the best with that!

 

Actually, "High Dose" is consider 1u per pound per DAY --- not BID --- so time to start thinking about acro and IAA tests.

So for 12 pound kitty currently at 8u BID === 16u per day ---- HIGH DOSE