Will be switching Pumbaa to Levemir soon...

Pumbaa has been on Lantus for nearly five months now. He's still bouncing and diving like crazy, and still hates his injections. We're just about ready to start his last Lantus pen, so it's time to order some Levemir and get ready to switch.

I'm going to order the Levemir from Canada, and try and save some money, so have to research that, unless someone has a suggestion of a good, reliable source who will ship in cooler packs (it's still bordering on the low 100's down here and will be for the next couple of weeks).

Anyway, I'm looking forward to joining the other Levemir users, and will pray that it helps Pumbaa stop this bouncing/diving routine.

Suze

 

My Shadoe did much better on Lev than Lantus. She was very edgy and had radical numbers when on Lantus. I am sure you will prefer Lev.

You may see nadir a bit later with Lev, and curves will be much less extremes.

if you want info on costs and shipping info for online purchases, make a change to your Subj to ask others about shipping details from various places.

 

Hi Suze!

You may want to do a search on "Canadian Pharmacies" on Health or, even better, to find reputable ones, check with some of our beans in Canada.

About 2 weeks ago I posted asking about the Canadian Pharmacies. There was a note in Brent's last package for Tigger about some current legislation that made me hesitate ordering from Canada. And some other stories from folks using Canadian pharmacies, only to have the insulin shipped from Turkey, and more than 2 weeks in shipping; ice packs room temp, etc. Just be sure to do your homework whatever you decide.

I also called around when I switched from ProZinc. Walmart, Walgreens and a local pharmacy. Walgreens had the best price - $189 with the prescription discount card (for 5 pens). You buy the card for ~$35, but it pays for itself on your first prescription.

I think there's also a coupon for Lev somewhere.... actually, I think it's on the post above/below entitled "your vet can get Lev samples for free." Click on the link and see if the coupons aren't there.

Will be curious to see what you decide!

Lu-Ann

 

Also scroll down to post "Is $220 ..."

viewtopic.php?f=10&t=76368

 

Thank you, Blue and Lu.

Blue, so glad to hear your Shadoe did so much better on Levemir. I'm praying I'll have the same results with Pumbaa.

Lu, I have the "Canadian Pharmacies" thread bookmarked, as I know the information changes often. I remember reading that someone's insulin was shipped from Turkey, but couldn't remember if it was Lantus or Levemir. The Walgreen's discount card would be great, but since I don't have any other prescriptions, it would be a wash for me, price wise, especially since the discount card is a yearly purchase. Did Walgreen's also accept your Levemir coupon? (I also have the bookmarks to the coupons for both Lantus and Levemir.)

I'll probably start doing my in-depth research around the end of the week, and then order the following week, to allow time for shipping, and so that I can transition Pumbaa before his last Lantus pen is half done, just in case I have to switch him back for any reason, like an allergic reaction, or whatever.

Suze

 

Suze,
I also got my Lev at Walgreens. They did accept my coupon for Lev. Actually discouraged me from joining the 'club' as my coupon gave me more money off. Maybe I will go that route next time. I hope Pumbaa does well with Lev. Missy has been on it less than a month, so a bit early to say, for her. She is still bouncing a bit, but the Lev seems to have mitigated it, somewhat. But, regardless of numbers, I have seen some nice changes in her behavior.....she is less hungry. (and she is overweight, so that is good) She has gone from a gobbler to a grazer. She is also starting to play more and do more of her 'old, normal' behaviors. For that alone I think it is worth the switch. Good luck to you and Pumbaa when you do the switch!

 

Grayson is an extreme high-dose kitty (insulin resistant) so I'm buying a box of pens about every 3 weeks. I haven't tried to use the coupons yet, first because I forgot about it, then because I needed it NOW. My vet just renewed my scrip, so I can pick them up this week. That will give me a chance to use the coupon. Now let's see if they'll accept it IN CONJUNCTION WITH the PSC. That would be really nice - cuz supporting Grayson's habit is becoming a mortgage payment! :shock:

 

I buy my Lev from Canada, via Turkey. They have been well packed and have all worked so far (working on my second package at this time). Cost for one pack of 5 pens is $115.

They arrived- the first in a heat wave- still cool to the touch and the ice packs, while melted, still had condensation in them. The second was was cooler to the touch but it was cooler when they arrived, too. Plus, high dose kitty like Grayson- I ordered three packs this time- $335 for 15.

All have been viable and have been doing good. If you have questions let me know.

Sneakers certainly did much better on Lev than PZI. Then again, she also does better on a high dose, so that might not be the best measure :lol: . She seemed more comfortable with it, how about that?

 

Holy moly...Sneakers is certainly a high dose cat. Yikes!

Haven't had time to research yet, but does all of the Levemir, including what is available here in pharmacies, come from Turkey? With the L insulins being so fragile, I am always concerned about their shipping and storage before I get them.

Here it is Thursday already, and I still haven't found time to research this. *sigh*

Suze

 

Spent some time yesterday talking to Pumbaa's vet trying to get a prescription for the Levemir.

I really love this vet! She had never prescribed Levemir for a cat before, and did some research, including calling another vet who specializes in internal medicine and who had prescribed Levemir for two cats. Unfortunately, that other vet stated that her patients had problems because Levemir is more potent than Lantus (and the caregivers weren't testing like I do).

But, thankfully, what my vet is taking into consideration is the fact that, unlike any other caregiver she has ever seen, I test constantly and keep detailed records, as all of you do. We also discussed how I would start Pumbaa at a much lower dose of Levemir than what he is currently getting with the Lantus, and then work our way up again, like I did with the Lantus in the beginning.

Still don't have the prescription because my vet was going to call some more vets and see if they had prescribed Levemir and what their results were.

Keep your fingers crossed that this doesn't get overly complicated, and I have to start Pumbaa at a new vet.

Suze

 

For the Canadian order you will actually sign up and order it, put in all of your information, and then you will need to print out a sheet of paper that has their fax number on it and take it to your vet to fill out the prescription on and fax it in.

While they said it would come from Turkey mine actually had an England return address on them.

This is who I use- https://www.canadadrugsonline.com/Login ... Sheet.aspx

Good luck!

 

Keeping paws crossed that your vet gets positive feedback and doesn't have an issue with levemir.

I don't know about the "more potent" aspect. I have heard that a few times lately. I think the average dose difference is less than 1u - maybe less than .5u? Anyway, I think it is more that their bodies process it differently and there are fewer "bouncy" kitties with lev. Overall, that gives lower, steadier numbers, but maybe not lower overall - meaning the nadirs are still in the same range.

Anyway - the perfect solution to that "problem" is home testing and taking it slow and steady. Which we all do. Brings us back to it not being an issue for you and Pumbaa.

 

Suze, I haven't ordered insulin for sometime....haven't had to...but when I did over a year ago I believe the difference between getting your order from Turkey versus straight from Canadadrugsonline.com is whether or not you order the cartridges or the flex pens.

Here is a copy of an email that I sent to them:

Subj: RE: Ordering levemir question
Date: 8/29/2011 8:55:04 AM Central Daylight Time
From: customerservice@canadadrugsonline.com
To: xxxxxxx my email addy

Hi,

The Flexpens will be shipped from Turkey and take 16-18 business days to receive.

The Cartridges will be shipped from Canada and take 10-14 business days to recive.

Thank you,

From: xxxxxx my email addy
Sent: August-28-11 3:51 PM
To: CustomerService@CanadaDrugsOnline.com
Subject: Ordering levemir question

I live in Illinois, USA.

I was wondering what the ship time would be for ordering the Flexpens versus the cartridges of Levemir?

Does one take longer than the other? Does one come from your pharmacy in Canada and the other from perhaps Turkey or one of your other affiliates where the ship time would take longer?

Thank you.

Pamela

Hope that helps.

 

Thank you, everyone!

Pamela, I'm still trying to figure out the difference between the cartridges and the FlexPens, and why the cartridges (which contain the same amount of insulin as the FlexPens) are so much higher in price. It appears that the insulin for the cartridges is produced in Canada as well as being shipped from there, per the Canadadrugsonline website, "Levemir is manufactured by Novo Nordisk in Turkey or Canada."

Suze

 

I just ordered Levemir from CanadaDrugsOnline. I have bought from them 3 or 4 times in the past, and always received the insulin in 5 business days and I live in New Jersey. I always get the more expensive insulin shipped from Canada, rather than the cheaper ones shipped from Turkey. I do not know how long the ones from Turkey would take.

I have asked them (I always call them to make my orders) several times, about the difference in the prices for the same amount of insulin, and they always tell me the less expensive insulin is from Turkey and the more expensive insulin comes from Canada.

Since freezing tempuratures are soon approaching, and I have two pens left, enough to last me until January or so, I figured I'd better buy now, before I would have to have tempurature sensitive insulin shipped to me in the dead of winter, and risk it freezing in transit.

 

That is pretty good. I might email and ask them about it.

I usually buy the pens- are the cartridge supposed to fit inside the pen? I just bought the cheaper since I will be buying so much over all and haven't had any trouble with the quality in the summer.

 

I'm going to email them and ask the difference between the cartridges and the flex pens...and see if they will send me photos showing each.

No time like the present...I just did email them.

 

Flex pen:


Cartridge (to the left of the box):


Another brand of cartridge:


The cart fits their older "pen" handle. The flexpen is the whole thing combined. You can't remove the insulin chamber from the pen. I like the flexpen because it gives you something to hold on to and it protects the insulin. They both get used the same for our purposes by drawing the insulin through the tiny rubber stopper top (you can barely see it in the orange carts above. For humans, on the flexpen there is a disposable needle tip you attach, then dial the dose and inject by pushing the button on the end near the dial.

Hope that helps.

There was someone that bought the cheaper product not knowing it came from Turkey and it took nearly three weeks to arrive (in FL).

 

Sheila, thank you! Now it makes more sense. And I agree that the FlexPens give you something better to hold on to, and help protect the insulin.

Unfortunately, the cartridges are more expensive ($160 for 5 @ 3ML) and it appears that those are made in Canada and ship from Canada. The FlexPens are less expensive ($115 for 5 @ 3ML) and it appears that they are made in and ship from Turkey. (Prices are from Canada Drugs Online.)

While some have reported having no problems getting the Levemir shipments from Turkey, I am concerned about the integrity of the insulin being compromised during the shipment from Turkey to Arizona, especially since we are still in the high 90's to low 100's during the day. *sigh*

Good thing I don't have Pumbaa's prescription yet, 'cause I have some decisions to make. *LOL* Wanna place bets that I just say "screw the savings" and just get the Levemir from Costco or Walgreens or some place local once I get the prescription?

Suze

 

I've gotten both Lantus and Levemir from Turkey and while it took a little bit longer about 2 weeks I think maybe a little less, both arrived in a cooler with a ton of ice packs that were still cool to the touch as well as the insulin still being cool to the touch. In fact the Lantus I started Autumn on in April was the Lantus that was ordered for Musette back before last winter in like July here.

Mel, Maxwell, Autumn & The Fur Gang

 

I can't remember if the FL person said how the insulin was packed, but it sounds like it is packed well. Maybe, if there was a problem, they are packing it better. There must be some kind of shipping option for meds that need to stay cool - like refrigerated containers, or even just heavily insulated containers.

You might ask the seller if they will guarantee a shipment from Turkey arriving safely - meaning, if the insulin is not potent, will they replace it for no charge?

And, I thought the costs/origins were the opposite: carts cheaper from Turkey and pens more expensive from Canada? My first order was carts - this was 2009 - at the same price as pens, but be the next time I needed to order there was the huge price difference. I wanted the carts, but I thought I remembered that they were more expensive...? Oh well...

Good luck with your purchase.

 

Yes, the carts are more expensive now. $115 for the pens, around $160 for the carts.

Well packed in a cooler, we were having 110+ days when I got my first shipment in and it was still cool to the touch and obviously potent.

 

Am I missing something or did everyone just stop selling FlexPens from Turkey or the UK or wherever they came from?

Carts from Canada apparently still available for $169. Super cheap Lantus solostar pens are still listed.

The local prices for Levemir (GoodRx.com) don't seem to have changed.

 

No, the ones I buy from Canada are sent from the UK. Or from Turkey via the UK.

 

They were there a few days ago but now they don't seem to be listed. :?

In fact I can't find cheaper FlexPens from Canada from anyone. The cheapest Levemir now seems to be the carts for $169?

The only reason I was looking was for Suze and Pumbaa, and planning ahead for winter.

Wonder if this is some seasonal supply issue, or if I'm not searching correctly?

 

You are right! I just checked my bookmark and typed in lev- all there were just the cartridges and the higher price for them. The picture, however was the pens.

BUT- when I log on I can still get the flexpens with the old pricing. And the price for the 10 package of 5 pens has dropped by $200. It is now $875 instead of just over $1000.

Very strange and unusual.

 

An idea...

It might be worth it for one of us to buy the 10 pack as long as they have them and the others pay for the packs they need. I think- if i did my math right, it comes out to $87/pack to do it that way rather than $115 for a single pack and $109 for the 3 pack.

Then again, the cost might be off-set by the shipping to each person.

Weird, right?

 

That is weird. Like they aren't taking new customers?

If you really knew for sure where Sneakers' dose was headed it might pay to stock up now.

Easy enough to sell the excess but the shipping might be an issue in the winter?

And do you have room in the fridge (even in the short term) for all those boxes?

 

One Canadian on line pharmacy is no longer selling drugs that need cool packs.

See here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=79411

Maybe others are following suit? I would call your pharmacy in Canada and ask to be sure.

 

The bad news is that my current vet won't prescribe Levemir for Pumbaa since she has never worked with it before. She did contact other vets for me, and give me three names of vets who have either used Levemir or who would be willing to prescribe it. Unfortunately, these vets are all 30 - 45 minutes away, and Pumbaa hates car rides as much as he hates being in the vet's office. Also, I really don't have time right now to get a new vet up to speed on Pumbaa. I am going call some vets closer to my house and ask them about their treatment of diabetic cats.

I'm very sad that my current, wonderful vet won't use me as the first time prescribing Levemir, since she knows how excruciatingly detailed my documentation is, and how regularly I test, and admits that tests in the vet's office are skewed due to stress of the cat.

:sad:

Suze

 

That is very disappointing. I can't understand this. Lantus isn't working for Pumbaa, in my humble opinion.

I suggest that you go to the other vet, get the prescription for Levemir, use it, and don't tell your regular vet. What difference would it make? -- this is a serious question to those who have used Levemir and Lantus. They both work on a shed, one has a later nadir, hardly a problem for Suze, and what other differences would there be that would affect any other treatment Pumbaa's vet might prescribe?

Obviously, if there is a particular issue then take the cat to the Levemir vet if that issue comes up. Tell the regular what you are using once the cat is regulated or if the cat has to be hospitalized or for any reason given insulin by the regular vet. However, I'm pretty irritated for Suze that her vet won't prescribe something that 3 other vets will prescribe -- make her drive that far to see them when this: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf indicates that Levemir can be used in cats in much the same way as Lantus. How can this vet call herself a vet if she won't do something that has been proven to help cats, and that isn't any more risky than using Lantus?

Very irritated. Sorry, Suze, this is not right.

 

Maybe Lantus is working - I took a harder look at your spreadsheet. At least you are getting Blues, and you are getting dose reductions. It'll be okay, but I would be as stressed as you are if Levemir users say that Levemir tends to help bouncy kitties. I don't think I could deal with this as well as you have, Suze. You are truly amazing. However, I read your notes on your SS, and my heart goes out to you. Hang on. I keep hoping Pumbaa will just stop bouncing like Max did, and it all started with dose reductions!

 

I am sorry to hear that was her decision. Yes, it does seem short sighted. She has documentation that lev is used in cats with success and that other vets will Rx it, but she won't because she never has. So, the failed logic here is that every single medication that she DOES Rx, she has, at one time, never Rx'ed before. Meaning, there has to be a first time. Can she really say she will NEVER Rx lev because she hasn't yet don't it?

Sometimes dose reductions, with either insulin, will stop bounces, but is seems like lev has a better tract record on that. I will say that with Beau, he was bouncing on .5u and a slight reduction stopped the bouncing, but he just sat in high numbers. It wasn't until I made a further slight reduction that this numbers started falling. I have seen folks reduce lantus to stop bouncing and have high flat numbers so they raise the dose back up and the bouncing starts again. That is what a did a couple of times with Beau before I figured things out. I just wonder if another decrease would work better even with lantus

 

That is maddening that the vet won't prescribe Lev for you. She might be telling you about those vets further away because she doesn't want you to go to someone inside her radius and therefore take her patients. Yes, i would call all of the ones closer to you.

When I was calling around for a new vet for Sneakers they kept referring me to those in Little Rock- 20 miles away mainly because of that. I found a vet about a mile from my house who lets me do a lot of things for my fur-baby- mainly b/c he knows that I do my research. Just like you do. He was unfamiliar with Lev too but read over the documents and articles I brought and I hope I am educating him in this as well.

I do have to admit, he might think i am sort of a pain and am happy that our contact isn't that often :lol: . his last comment when I said I would not use metacam for Sneakers was "... you've been researching again, haven't you?" :lol:

Hopefully you can find a vet with more understanding.

 

Yes, Dale. Then 10 packs wouldn't take that much room. It's just me at home and the pens can live very nicely on the second shelf in a large tupperware box.

Depending on how Sneakers keeps going I might do the 10 pack. I saved a chunk of change for Sneakers meds so actually have about half of that.

 

I may have a vet nearby who will prescribe Levemir. My mom takes her cats to this vet...and the only reason I never did use them is because they aren't open on Saturday.

Keep your fingers crossed for me, everyone. I hate to admit this, but I have actually been considering putting Pumbaa to sleep because I can't go on like this much longer. And that has made me cry, a lot, the last few days.

Suze

 

Suze, I know you are extremely frustrated right now, but Pumbaa is no where near a point where he should be PTS. So, put that out of your mind and relax, take a deep breath (or two). OK? I know you have a lot on your plate, but lets see if we can get him to better numbers and stop bouncing.

(BTW, I can read all your notes, etc., on his SS - seems to be working ok)

How prone is he to ketones? If you have not seen any since the beginning, I would suggest dropping the dose and see if his numbers even out a bit. Right now he goes from low 400s to 40s and back. If you dial back the dose maybe he will stay between mid 100s and 300. Wouldn't that be better? - at least you could get some sleep and sleep makes everything look more doable.

I am thinking 1.5u for now, but I wonder if he might need less that that? He was started at 1u instead of .5u, so the doses below 1u are an unknown.

You need to be testing for ketones if you drop the dose.

What I found with Beau (on lev) was that at a slightly too high dose he stayed high and flat (no greens), but at a little more than that he started bouncing with higher highs and lower lows. Is wasn't until I reduced enough that his numbers improved. I switched back and forth between .4u and .5u several times not getting "better" numbers. .4u looked like not enough and .5u dropped him into the 30s and 40s. Finally, I tried .3u and his numbers evened out, the curve lowered and I stopped pulling out my hair.

The other thing is that I switched him to lev on mu own. I had asked my vet about it and she had little knowledge of it and wanted to go to lantus and "start over". I had done my research and wanted lev, so I bought it on my own. Easier to do back then as I did not need a script for ordering from Canada, but I bet you could obtain a pen from someone at cost plus shipping. It should last you at least 3-4 months, maybe longer if he is on a lower dose. If you did that and showed the vet his numbers and said it was "start lev without your approval or have him PTS" maybe she wouldn't be that mad. Cross that bridge when you come to it, I guess. When I told my vet Beau was on lev she didn't act surprised - or mad. And when he went OTJ a few months later she was pleasantly surprised.

What do you think? Obviously try calling the vet your mom uses and ask them if they will Rx lev, but I think you can get it yourself if you are determined enough.

 

Sheila...just real quick...I had contacted this vet office yesterday to see if any of the vets had worked with Levemir. They called me back this morning and one of the vets was going to do some research on it. I quickly emailed him Pumbaa's history, a link to his SS, information about Lantus vs. Levemir, and the Roomp/Rand report. He accessed my email about 1/2 an hour ago, so my fingers are crossed. The vet tech I had spoken to this morning was simply tickled to know that I home test and keep documentation like this, and said that I would be the kind of person their vet would love. She also agreed that the vet who told my vet how "dangerous" Levemir is was an idiot and dosed too high for a cat not being home tested. This vet tech from this morning even stated, "we all know that running curves in our office produces stress-related abnormalities in the numbers." Well, Yeah! *LOL*

So...fingers crossed.

Suze

 

Fingers - and paws - crossed!

At least the vet tech seems like she is on the ball and current with standards of practice. Might not be such a bad thing to switch to this vet.....

 

Excellent news! I have a new vet for Pumbaa, only 5 minutes away, who will take over Pumbaa's care and prescribe the Levemir. I have an appointment Monday morning.

Here is what the vet emailed me after going over Pumbaa's SS and other information I sent:

I'm sitting here crying again, because this is SUCH a relief!

Now, back to work if I can see through the tears.

Suze

 

So happy for both of you :RAHCAT

 

He sounds like he is open minded and like working with people who are part of the team - rather than sheep following the leader. I hope it all works out well for you.

Yay! :thumbup

 

Happy (((hugs))) all the way from Arkansas!

 

Okay, some of you might think I'm absolutely insane, but, due to Pumbaa's bouncing and diving, I made a couple of decisions this afternoon:

1) He is now off the Lantus, and has 6 cycles for the shed to empty before he starts on the Levemir Monday evening. (At testing/feeding/shooting time tonight, he was, once again, hiding under the futon in the guest bedroom. I don't want my little guy hiding from me at shot time anymore.)

2) I no longer care about saving $40 and ordering the Levemir from Canada and having to wait. I WILL call around this weekend and then, as soon as I have the prescription in my hot little hands on Monday, I will be filling it so that I can start Pumbaa on the Levemir Monday evening. (Barring once again getting bitten at the vet's office and winding up in the ER again.)

3) I will still be checking Pumbaa's numbers from now until Monday night, to see how he does off the insulin. I will also check him for ketones every day now, until he's been on the Levemir long enough to have decent lower numbers. What I am praying for, numbers-wise, are flat mid-200's, and an end to to roller-coaster of bounces and dives.

4) I need to rethink my shooting times, due to potential later onsets and nadirs. Then again, the 7 am/7 pm schedule has been working really well for me, and if Pumbaa has later nadirs on the Levemir, that just means that I get to nap longer on the sofa before I have to test him at night.

Once I got the email from the new vet this afternoon, and I had time to let go of the stress from the quest for Levemir and the contemplation of putting Pumbaa to sleep, I can't tell you how much easier my life has become. I know that Pumbaa may continue to bounce and dive on the Levemir, but I am praying that he doesn't, especially since I am letting the Lantus shed deplete in advance. I'm praying that he does as well as Dale's Chip is now doing. I'm praying that he stops hiding from me at injection times because the injections will no longer sting. (Yes, I know they sting him, because he barely flinches when I put the needle in, but once that Lantus has entered his sub-skin area, he stops eating, looks at me with shock, stands there for a few seconds and then walks away from his food. He wouldn't react like that if the insulin didn't sting.)

I will weigh Pumbaa tomorrow, and then ask for recommendations on a starting dose for Monday night (in a new thread).

In the meantime, I have turned off my 6:55 am and 6:55 pm alarms on my phone. I'm sure I still won't be able to sleep in in the morning because Beck has been getting me up lately before the alarms even go off. But I think that those alarms not only alerted me that it was time to test/feed/shoot, but also notified Pumbaa that it was time to go into hiding mode.

I think both Pumbaa and I are going to really appreciate this 6-cycle break from injections.

It's okay if you tell me I'm crazy for doing this.

Suze

 

Crazy? Yeah a little bit.

I am (very) concerned about him not having any insulin for 3 days. If you are seriously thinking this is an OK thing to do, can I talk you into shooting .5u of lantus instead? You do not need to let all the lantus clear his system before starting lev. You can just start it 12 hrs after the last lantus.

He may be hiding from you because of the roller coaster ride he has been on. A token dose of insulin may allow his system to clear the rebound hormones - something that is probably going to be more of an effect on the lev than the lantus itself if you went from his current dose to lev in one cycle, but I still think he needs some insulin. And a smaller amount might sting less.

Lev (or any insulin) should NOT be dosed by weight. I would suggest starting him at .5u of lev simply because Pumbaa has not been on a dose as low as .5u and you might as well find out how he will do on it with this switch.

Bring leather gloves with you to the vet! You don't want another bite. Jeddie bit me very hard in the first few days I had him. Ouch! I wore leather gloves to test, and burritoed him for several weeks. It's not easy to test wearing gloves, I can tell you. He was OTJ for three months after I got him, so I wasn't having to test very often at least.

 

Sheila:

Thank you for your concern, support and suggestion to give Pumbaa some token dose of Lantus in the next 6 cycles. (((HUGS)))

Pumbaa is hiding under my bed right now, and it could be because he still thinks I'm going to shoot him with Lantus tonight, or it could be because of the bounces and dives. I don't know, but it breaks my heart when he does this. That's why I wanted to give him a break from the Lantus for 3 days...so that when we started on the Levemir he might have forgotten that the injections sting.

I didn't shoot him tonight, but will consider giving him a token dose in the morning. But do you think his numbers would be higher without the Lantus than they were before he ever received any insulin back in April? I was hoping they would be lower and that that would show that his pancreas is working a bit again. I'm just really interested in learning why you think it's important give him even a token dose of Lantus. To prevent ketones from showing up? To keep his body used to receiving insulin? To keep his pancreas in healing mode?

And thank you, I will start Pumbaa on .5U of Levemir Monday night. I know it's a more potent insulin, and don't want to start him too high. That was another reason for my not wanting to give him Lantus for the next 3 days...to see, once again, what his numbers are like without any insulin, 'cause they weren't that high (336 at the vet, 277-327 at home) when he was first diagnosed.

Sheila, I truly appreciate how you think outside the box!

Suze

 

Sheila, I gave Pumbaa a token .50U of Lantus this morning, and he didn't flinch, stop eating, stare at me and then flounce away.

Go away, rebound hormones! I never, ever ever want to see red on Pumbaa's spreadsheet again!!!!

Suze

 

I am glad to see that you gave .5u this morning and that he did not react to it the way he has previously. That's a good sign.

The reason I am concerned about him going 3 full days without insulin is that if he needs it, going without it could cause several problems. Ketones is one, dehydration is another as his body tries to flush the extra sugar from his system, and developing insulin resistance to a degree is a third.

Unlike before he was diagnosed, where is body got used to a slowly increasing amount of circulating blood sugar, suddenly stopping insulin would be a big change that might cause some sort of shock to his system. Plus, if he has been rebounding where pumping out rebound hormones and stored glucose has become the norm, his body will continue to do that for several days until it realizes there is much less insulin to compensate for - thus leaving him with the pendulum swung to high BGs for a period of time.

Get some spot checks as you can and PS tests. It will be interesting to see how he handles the much lower dose. Expect him to be high today though, for the reasons I mentioned above (rebound hormones, etc.).

 

Sheila, thank you so much for the explanation of why giving him a token dose of insulin is important. I could take him up to 1.0U instead of a token .50U tonight if you think that would be even better.

 

I think that if I had been in your place, about to switch to lev, I would have dropped him to 1.5u just to see if his numbers got better. However, you are going to be starting him at .5u of lev in a couple of days, so his numbers will be all over the place for a while until things settle down and you start finding the best lev dose.

As for making the decision on .5u vs 1u for tonight, I would want to see where he is at PS. I think that if he was lower than the current 355, I might be inclined to leave him at .5u and see if he settles even more on it. If he is back in the 400s, I would probably shoot 1u.

That 454 is probably that "push back" from the rebound hormones I was talking about that swung his BGs way high because they didn't have any insulin to push against, but you don't want him in the 300s and 400s.

I have to run some errands, but I will try and be back at 6pm my time and see if there is an update.

 

Sheila, my pre-shot time is 7 pm Arizona time, which is 9 pm Chicago time (right now, anyway, until you all change time at the end of October). So don't hurry on our account.

Thank you so much...there's so much I didn't consider. I just wanted that Lantus out of his little body.

 

From where he has been this afternoon, I would give him 1u.

The lantus will be gone soon enough. You just don't want to take too many risks in the next 48 hours.

At 9pm, I will probably be just getting back from my neighbor's who's cat I am watching this weekend. I'll check, but I might miss your shot time. But I doubt there will be any huge changes that would make me suggest other than 1u.

 

Thank you, Sheila.

At least Pumbaa was consistent...he was still at 355 for him PMPS so I gave him 1.0U. And, no flinching from Pumbaa when the dose was 1.0U. If Pumbaa goes above the mid-300s at his AMPS, I will probably raise him to 1.50U. But, hopefully, that won't be the case.

It will be interesting to see what he does tonight, and if we can tell how quickly he reacts to a dose change like this. At least with the Lantus. He may react totally differently on the Levemir.

In all seriousness, while I did expect his numbers to flatten out once he stopped the bouncing and diving, I really didn't expect him to settle into mid-300 numbers, especially since the insulin stored in the shed should still be distributing itself. :YMSIGH:

Dealing with Pumbaa these last 5 months has been the one area in my life (other than dealing with my mom *LOL*) that defies all of my logic and common sense.

I need to make time tomorrow to go back to the beginning and read up on FD, Levemir, Roomp/Rand, SLGS, and prep myself for Monday night. Since I have been on auto-pilot with Pumbaa for the last month due to the excruciating deadlines I have been working under, I feel like I have forgotten a lot, or maybe I just never grasped it from the start, or maybe all of the new things I've had to learn for my business in the last month has crowded out everything about FD. Maybe it's just the stress and total exhaustion taking its toll. In any case, my brain is fuzzy these days on anything not concerning the projects I've been working on.

The good news is that I really don't have to worry about Pumbaa taking a dangerous dive tonight, so maybe I can go to bed early, and get a glorious 7 hours of sleep! (Shhhhh...clients haven't sent me any new corrections tonight...so my slate is actually clean. I need to log off of email to make sure I don't see anything coming in. *LOL*)

Suze

ps: if something I typed above didn't make sense...blame it on my very foggy brain.

 

I am not surprised that he is in the 300s. You have suddenly removed a component that was active in keeping him where he was - even that was going form 400 to 40 and back. But I also think he was rebounding from those 40s and that means his body was exerting a force against the action of the insulin (by releasing hormones and stored glucose). Think of two forces pushing on each other and then suddenly remove one of them. What happens? The other one flies forward by its own force because resistance was removed. Make sense?

Also, the lantus is not hanging around somewhere slowing being used up. It was being used at a rate that was replenished every 12 hours - meaning since he went 24 hours between shots the "old" stuff is all gone already.

Those two things equal really high numbers, but they probably will come down at least a little over the next 36 hours.

I would plan on staying at 1u and let the rebound hormones clear so that the lev has a "clean slate" to work from.

You are testing for ketones right?

 

Sheila:

First and foremost, just checked for ketones and they are still negative, thankfully!

I truly appreciate the rest of your informative post, and hope and pray that you will guide me during Pumbaa's switch to Levemir.

(((HUGS)))

 

Yep, I will be around. Will be interested to read your report from the vet visit tomorrow.

 

Sheila, and I'm interested in having his blood tests done again to compare to 5 months ago.

 

Can you believe that Pumbaa went down to 206 on 1.0U???? Now, if only he doesn't bounce because of this!

 

Cool! I think those rebound hormones are starting to clear. Keeping paws crossed that he doesn't bounce back into the 300s. Remember, with a smaller dose and rebound response fading, he may just stay steady in the 200s - similar to where he was at diagnosis. Then again, he might sag into the 100s now that he doesn't have to fight a too big dose.

 

Wouldn't that just be fricking awesome????????

 

Yep. :mrgreen:

 

I absolutely love this new vet!

First of all, Pumbaa didn't bite anyone, and only hissed once, at it wasn't even when they stuck the thermometer in his butt! *LOL*

The vet did an overall exam (even his teeth), and said that clinically, Pumbaa is in excellent shape! He went over Pumbaa's last blood work results (taken when he was being diagnosed) and said that, unless I wanted to throw my money away, he saw no reason to repeat the blood work as the numbers he saw were all indicative of Pumbaa's FD, and there were no clinical signs that Pumbaa was having any problems.

The vet (a big, boisterous guy, probably in his early 50's), said that:
• They normally prescribe Lantus as the initial insulin of choice for cats;
• They see a lot of diabetic cats;
• Very few of their patients home test their cats;
• While he has read up on, and knows that dry food is bad for cats, he hasn't switched his cats over to a wet diet yet. (I told him about using parmesan or FortiFlora and he was amazed.) But...this vet admits that dry food (for cats and dogs) is "a convenience for the owners and not the best thing for the pets";
• He's looking forward to seeing how Pumbaa does on the Levemir.

Now I need to call around and get prices so I can get this prescription filled this afternoon!

Yeehaw!!!!!! :RAHCAT

What a relief. And I will be switching Beck to the same vet!

Suze

 

Fabulous! Glad it all went ok. That vet sounds like he is "practical" about what people are able and willing to do as well as what is necessary and not. I do hope you can get him on board with recommending wet food for cats - and switching his own. He may not know that you can free feed wet food and leave it down all day. Maybe direct him to Dr. Lisa's site? (catinfo.org).

Just have to say that the logic of convenience over proper nutrition is lost on me. Would it be ok for parents to hand their kids a bag of chips and a soda for every meal because it is convenient? Or even give them a fast food cheeseburger, fries and soda for the same reason? It would sure be "easier" at least until the kids started having severe health issues that no one could figure out the cause of because they would never look at diet... geeze. Come on, people!

And don't forget to mention to the old vet why you switched. That it had nothing to do with skill or personality and only with the unwillingness to Rx a drug that many cats are already on ......

 

Yay for the new vet!!!!

Sounds like he is willing to learn and is not such a stuck in the mud.

 

Thank you, all! (((HUGS)))

Yes, this new vet is very open and honest. Not just for telling me I didn't need to pay for a new blood panel, as Pumbaa didn't clinically exhibit any symptoms of any of his high/low results from his April FD diagnosis blood panel, but also for admitting that he knows he should get his cats off of the dry food, except that they are resistant to the wet food (which is why he got excited when I told him to try parmesan or FortiFlora). He can even take a joke, because when I told him my advice on this was free and I wouldn't charge him, he pointed to his credentials on the prescription form, winked, and said "but I have these letters after my name...DVM".

I really, really like this guy! He was pleased/excited when I told him that the link to Pumbaa's SS was kept current every day. And my mom has been taking her cats to these vets for years now. Again, the only reason that I didn't switch my animals to this vet's office about 4 years ago when I was changing vets was because, at that time, I worked outside of the home, and they didn't have Saturday hours.

I loved my previous vet as well. But she was about 10 minutes further away, and more expensive, and she wasn't willing to take the risk to prescribe Levemir for the first time to a cat, even based on my history of testing/caring and knowing that Levimir is more potent so you start them at a much lower dose. So now, she has lost my business for Pumbaa and for Beck. How sad. (Yes, Sheila, I will be telling her exactly why I am moving both of my animals. I don't need the headache of different vets for different pets, and, since she was unwilling to prescribe Levemir for Pumbaa, they have now lost all of my business.)

Pumbaa got his first dose of Levemir tonight! 0.50U.

I am very exited about this!

As for prices:

WalMart was the highest at $236.32. Walgreens was next at $235.00. Costco had the best price @$222.64, and said that they would honor the $25 off coupon, but then didn't when they said that the coupon prescription had to be from a VET/MD in some national network. But, still, I only paid $193.60 due to my Costco membership and some forms I had filled out when I got Pumbaa's Lantus there five months ago. I would have paid $160.00 plus shipping charges had I ordered the cartridges from Canada. Also, when I called the pharmacies today for pricing, I also asked about the country of origin for the Levmir, and how it was shipped and handled. Costo couldn't tell me country of origin (Walgreen's said Denmark), but did verify that the Levemir was shipped refrigerated and was then stored, refrigerated, ever since.

$196.30 isn't too bad when I know this insulin has been cared for correctly. And when I'm too impatient to start Pumbaa on this new insulin to order from Canada.

Suze

 

Isn't it awesome when we find vets like this????

 

"..a stuck in the mud" has got me laughing twice today! :lol:

Did you discuss starting dose with him? I'm just wondering what his thoughts were, if any, on that.

 

New vet started quoting percentages of current Lantus dose, and I stopped him and said that a very wise person who has been through this many times (that would be you) suggested starting low and slow at .5U, and seeing how Pumbaa reacts to this more potent insulin, and he was fine with that! (((HUGS))) to you, and also (((HUGS))) to the new vet for realizing that he would be following my lead on all of this, based on what I learn here and what I do due to frequent home testing, since he has never prescribed Levemir before.



Suze

 

I figured it would be Costco. But I can't believe they wouldn't take the coupon.

When Walmart pulled that one on me after waiting around more than an hour, I stormed out of there demanding the script back. That was after he twice told me I wouldn't be getting the script back. Actually he processed the coupon but the final coupon price was higher than the everyday low price. Then he tried to claim the everyday low price was the manufacturers list price, after I'd already called before hand.

They must assume most people will just pay whatever they ask.

But now the fun begins, get some tests just to keep track of what happens the first few cycles.

 

Dale: Using the coupon would have been nice, but going back to Costco for the insulin alone saved me $42.72 over what I would have paid had I gone to Walgreen's, so I'm not unhappy over the price I paid. It only hurt for a minute. Hahaha!

I'm really looking forward to testing Pumbaa again these days...while praying for some Levemir magic. <-- insert anti-jinx. nailbite_smile

Suze