Introduction - Stitch - 11YO BG > 700 when Diagnosed

Really glad that I found this site! I've been looking for practical advice and have already found answers to many of the questions I had. My 11 year old cat was diagnosed Dec 28th with Diabetes. Vet suggested an insulin that cost $360 per vial, but the pharmacist offered up an alternative (Novalin) at $25 a vial, so we are trying to see if we can make that work. 1st week at 2 units 2X per day seemed to be working and brought BG levels down to ~250 10 hours after shot, but a recheck 2 weeks later 4 hours post shot and levels were over 300 and the thirst and urine had both increased so we upped the dose to 3 units 2X per day. Stitch is a big boy (was 17+ pounds pre diabetes, lost 2.5 pounds over a month or so and has gained back 9 ounces in 3 weeks since starting treatment). The vet thought that perhaps the weight gain drove the need for increased insulin, so we'll be back in two weeks for another check. Fingers crossed!

 

Welcome to the FDMB!

The insulin your vet suggested is most likely Lantus or Basaglar (Glargine) and it's an excellent insulin for cats. Most of us buy ours from Canada because it's 1/3 to 1/2 the price. Here's the Info on Buying insulin from Canada

A 5 pack of pens will last most cats at least a year and some up to 2 years so it becomes a lot more affordable.

Novolin really isn't usually a good choice for cats. It works well in dogs but cats have a higher metabolism. It tends to hit hard and fast and then wear off before the next shot it due. I absolutely can't understand why pharmacists say that Novolin is the same thing because they couldn't be more different (it happened to me too when I first started)

Next, your vet is raising the dose too much at a time. We only recommend going up in .25 to .5 unit increments.

We are big proponents of home testing here. Tests that are done at the vets office will be influenced by stress hormones which can raise the blood glucose up to 200 points. By testing at home, you'll not only keep kitty safe but you'll get more accurate results. Most of us use human meters like the Relion Prime from WalMart. It's only $9 and 100 strips are $17.88.

What are you feeding? A diabetic cat needs to eat a low carb canned or raw diet. Most of us feed Fancy Feast Classics, Friskies pates or 9-Lives ground because they're under 10% carbs, easy to find and affordable. The "prescription" foods are too high in carbs and don't have anything in them that actually treats disease (the ingredients are pretty lousy too)

Hang in there....You can do this and the people here will help!!

 

Hello and welcome!

I hear you about the expensive insulin, but Chris is right, the Novalin isn't the best option for cats. Now, if that's all you can afford, it's all you can afford. No one here is going to judge you for that. I wanted to suggest you talk to your vet about ProZinc insulin. Many folks, inclucing me, have had good results with the ProZinc, and it tends to be cheaper than the Lantus. We got a vial that we expected to last for 2 months (depends on dosage of course) and it cost $120. The thing is, the Lantus or ProZinc gives your furbaby the best chance to go into remission, which will save money in the long run and help you cat live his best life. It's worth thinking about.

And I agree 100% with Chris about home testing. Without home testing and the folks on this awesome site, we would have lost our Billy on day five. Now, he's heading into remission. Every cat is different, but the information on this site will give your big boy his best chance at remission.

 

Note that ProZinc is a U40 while Lantus is a U100. Thus 1000 units of ProZinc would be $300 vice $320 for 1000 units of the the vet recommended insulin, assuming it was Lantus..

 

Ah, I see. So the ProZinc isn't less expensive, you just can buy less at a time.

 

First things first: did you purchase Novolin “N” (NPH) or Novolin “R”. That is a very important piece of information.

If you haven’t done so, please read the Novolin/Humulin N primer and take note of the recommendations therein:
http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

It would also be a good idea to prepare a hypo toolkit.

I too, based on price, would guess that the insulin the vet recommended is Lantus (glargine) or Levemir (detemir). Those are excellent insulins for cats and show that your vet is at current on that part of feline diabetes treatment.

The pharmacist might be an expert in human medications but I question whether he has expertise in veterinary use of those drugs. Cats are not simply small humans ... and that is a very important point to remember.

Insulin is a powerful hormone. There are multiple types and brands available and, although they are all insulins, they are NOT interchangeable. Each has slightly different makeup and definitely different action. Think of it in terms of an amusement park: there are multiple “rides” in the park, but you’d never expect the same experience from the Teacup Ride vs. the Super Screamer Rollercoaster. The Teacup ride is gentler, the rollercoaster hits hard and fast and flings you up and down. Some rides last longer, such as floating a tube down the Lazy River, others are over in two minutes. The point is that the label is the same but the result is different. The same is generally true for insulins.

In the old days, Novolin N (or Humulin N) was prescribed frequently. It is sometimes called a “harsh” insulin because in many cats it hits fast and hard and wears off well before the next shot is due, resulting in a deep “U-shaped” curve if you plot the blood glucose readings ( e.g., 350 to 90 to 350). Lantus and Levemir, on the other hand, have a reputation for allowing a cat to reach a point where they surf along in a small range of BG numbers all day. They also have a pretty decent documented remission rate.

I tell you all of this not to make you feel guilty. Finances are a real thing and sometimes we just have to do what we can. However if you chose Novolin because the pharmacist gave you the impression that it was a cheaper version of the same thing, well then I want you to have enough info to make an educated decision — it seems like a no-brainer to get the less expensive option if all other things are equal. I just want you to be aware that not all other things are equal. You’ve already been provided info about getting Lantus/Lev from Canada if you choose to rethink your insulin choice.

Some people have used N successfully and it works well for their cat. Others not so much. Every cat is different. Again, please read the primer linked above and please be sure to get multiple mid-cycle tests and be conservative with dose increases (quarter unit at a time, for example). I’ve just seen too many people innocently get in trouble with N and other faster-acting insulins over the years and the results can be heartbreaking. And preventable.

For what it’s worth, I remember well my first foray into feline diabetes. There was so much to learn — insulin types and strengths, different syringes based on the type of insulin, needle lengths and barrel capacity, various blood glucose meters and lancet devices. I also remember how the insulins all looked the same and it was hard to wrap my head around how such a tiny amount of liquid could be so powerful and even potentially dangerous. Heck, I didn’t even know what the normal BG range was for cats so didn’t even know enough to be afraid of a crash (I learned that quickly, though!).

Kudos for educating yourself and for reaching out. Please ask whatever questions you might have and we’ll do our best to help. And welcome to the board, btw.

 

Prozinc is only $100 if you order through chewy.com

 

Yes, Lantus was what he recommended as the best option but I have to admit the sticker shock at $360 Kroger/$340 Walmart was hard to take if it was going to be every month for the rest of his life. The pharmacist gave me the option of Novalin N as an equivalent at $25. I read somewhere that while I could buy the insulin in Canada, it was illegal to import to the US? Is that not true? For human prescriptions, I know I need a script written by a Canadian physician - is that also true for a cat? do I need to find a Canadian vet to write me the prescription? I am over in Canada regularly so if I don't need a unique script, that would be great. The vet didn't mention anything about testing at home, we talked more about watching physical symptoms like thirst, hunger, urine output. The Novolin seems to work based on those things, even at 2 or 3 units for about a week, then all the excessive thirst and urine output come back. My next appointment is a week away, so I'll talk to him then about Prozinc or a Canadian Lantus option.
As far as food, he had crystals in his urine when he was younger and since then he's had Friskies Ocean Whitefish and Tuna shreds almost exclusively to get his water input up. I do have another cat, so there is dry food available to him but until this recent issue, he stuck to the wet food. Now with the ravenous hunger, he is eating the dry as well.

 

ok, so I should have read the post on buying insulin in Canada first! Answered a lot of my questions. I still have the script for Lantus, so I think i'll try to order some online so I can take it with me next week. Thanks for the advice!

 

Another thing about Lantus: a vial lasts a lot longer than a month. For human use, the FDA only allows Sanofi to claim it's good for 28 days once punctured, but most vets recommend it as being good for up to 6 months if properly stored/cared for.

 

If you're over the border into Canada, I don't think you need a prescription to buy Lantus. It's sold over the counter there.

I'm more than a bit shocked that the pharmacist offered to switch the insulin. If the vet prescribed Lantus, unless the pharmacist called your vet, he did not dispense what was prescribed and that's illegal. The other option was that the pharmacist could have sold you one pen. The cost is a lot less for a single pen than a vial or a box of pens. All of that is moot since you're planning on order Lantus!

One of the goals we have here is to help your cat reach either regulation (staying in normal numbers) or remission (off of insulin altogether and the diabetes is diet controlled). So when you're thinking of managing Stitch's diabetes, it may not be a forever thing -- it may be but only time will tell. Lantus has a very good track record for getting newly diagnosed cats into remission.

While you're waiting for your insulin to arrive, I'd encourage. you to do some reading. There are several sticky notes at the top of the Lantus board. They will help you to get familiar with how Lantus works since it's very different from the insulin you're currently using.

This post will help you get oriented to FDMB and will provide links to guide you on setting up your signature and your spreadsheet.

Please let us know if you have questions. We're all here to help.

 

Lots of folks cross the border to Canada to get insulin for their sugar cats or themselves; seems to be no problem except many pharmacists do require scripts, so I'd take one along to be sure. M'row started on Lantus one unit twice a day 12.5 months ago, but I quickly dropped that down to half a unit twice a day after a hypo in the first month. We are about 80--90% through his first 10cc vial right now: hope that's helpful for you. Suddenly, at 12 months in, he's approaching remission, yay!! I plan to check blood glucose daily for awhile, and if he's stable poanpto then check blood glucose weekly, forever. Our lantus still looks great: totally clear. I store it in a snap-top little box in the refrigerator, and swab down the top of the vial with an alcohol swab right before I draw up the insulin. I don't ever re-uses syringes, and if I contaminate the syringe (like drop it on the floor) I just throw it out because I don't want to risk contaminating and then having to throw out that expen$$ive 10 cc vial. I've only forgotten and left the vial outside of the refrigerator until the next shot twice. I keep the snap top vial (it has a gasket, too.I bought it in the supermarket.) in the top shelf of the refrigerator to prevent miscellaneous things from dribbling on it. An when I draw up insulin, I inject a little air (a whole unit for a half unit shot) in the vial before drawing up. This way, vial contents are seeing positive pressure and are less likely to suck in contaminants.Hope this is useful!!