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July 31st, 2013

(no subject) @ 11:52 am

Hey veterinary friends... Passing along a question from a friend from elseNet. She's getting conflicting adivce from her vet and pharmacist.

"My own discontent: I'm getting some really conflicting advice between my vet and my pharmacist (and the prescription documentation). Maybe someone will know more about this.

In short: my very old cat was recently diagnosed with diabetes and was put on insulin, just as a normal diabetic would be. Among other things, I was told that this expensive (for me) bottle of insulin would last her six months, and that it should be kept refrigerated except for the brief time it takes to pull out the insulin.

So I go to pick up the medication and the pharmacist tells me that insulin is only good for 28 days, after which the effectiveness dramatically drops. Also he said that I should keep the bottle out for 10 minutes before I inject Nikki with the insulin, otherwise it will be painful to her (or at least he assumes so, because cold insulin is painful to humans). He also said it doesn't need to be shaken or rolled, as I was instructed to by the vet. It was also $60 more than I was told at the vet that it would be, which is bad enough for my income, but moreso if I'm to be purchasing a new bottle of insulin every month. But whatever.

Anyhow, since the effectiveness of the insulin is sort of a big thing, I called the vet's office this morning. I was told that the insulin would, in fact, be okay for a cat for six months' time, and definitely not to warm it before injecting her with it. I am resigned to injecting Nik with cold insulin, as I'd rather err on the side of caution and it's just a small amount (one unit, if that means anything to you). However, both the pharmacist and the inclosed documentation that came with the insulin say that it's no good after a month but the office was certain that it'd be good for half a year. I know that there's a lot of difference between a human diabetic and a feline diabetic, but I assume that that would be addressed in the smaller dosage and that the degradation of the medication is a separate matter entirely. It's pretty frustrating to me because I really do just want her to feel better and keep on Nikki'ing. She's a very good kitty."
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Date:July 31st, 2013 09:42 pm (UTC)
wookiemonster is currently giving Rocky insulin, he may have answers to this. (If he's not on your list, he's on Brett's).
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Date:August 1st, 2013 03:09 am (UTC)
Rocky's insulin has an expiration date, which shows it to have been good for a year from when I got it. Being that it is now almost a year (he was in remission for about six months, where the insulin sat in my fridge "just in case") since I got that ampule, he is still eating and acting normally (well, normal for him, anyway), and his last veterinary glucose check showed his glucose levels to be well-managed. So, I'd say that your veterinarian is correct in this case.

Also, if you are "tenting" the scruff of the neck, as I'm sure your kitty doctor instructed, you are (1) pulling the skin away from the body, whereby the coldness of the insulin is much less detectable and (2) you're pinching the skin, which distracts your cat from both the needle prick and the coldness of the medication, and it will quickly get to your cat's normal body temperature. Besides, unless you're needing to use more than, say, 10 units, it would probably not feel any worse than a drop of cold water would feel.

My cat, Rocky (seen in the icon) is on Prozinc insulin, which is human-grade insulin and tends to work better for felines, so, if your insulin manufacturer is different, your mileage may vary.

Lastly, discounting the remission time, Rocky's ampule lasted about four or five months at 5 units twice a day.

Hope this helps...
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Date:July 31st, 2013 10:49 pm (UTC)
There is no right or wrong answer to this.

The efficacy of insulin does decline over time - the molecules break down, so when a bottle is older it doesn't work as well. The FDA approval is for one month for most types of insulin, give or take.

How quickly does it degrade, and for how long is it actually good? Studies haven't been done. I know that when I put an animal on insulin, I usually explain to the client that the recommendation is to get a new bottle every month, but that a lot of people can't afford that and that I understand - but that if they're using expired insulin, it may not work as well or at all. And if an animal on insulin isn't doing well, one of my first questions is 'How old is the insulin?'

As for temperature, I can't imagine that warming or not would make that much difference for one unit of insulin, comfort-wise.

Ultimately, when it comes to veterinary medicine, I trust the veterinarian who is trained in animal health and medicine over the pharmacist, who is only trained in human medicine. Animals are not humans, and they often respond very differently to the same medications - it's not possible to extrapolate from one to the other, in either direction.
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Date:August 1st, 2013 01:37 pm (UTC)

Per my Veterinary friend

Hey jess - it very much depends on exactly WHAT type of insulin she's getting. There are several different types/brands. However, I don't have to use it very much, so I honestly can't say that I know the answer to this question. The normal veterinarian uses and prescribes it daily though, and is very very familiar with it. So I think I'd probably trust the veterinarian when it comes to that specific insulin and cats. My guess is that the company/pharmacy has to say that it expires in a month, but the veterinarian is working with clients without insurance to help pay for it, and maybe has seen that it remains effective much longer as long as it is always kept refrigerated. A human goes through a lot more insulin than a cat, and I'm sure many many clients choose to keep a bottle of insulin longer than 30 days because they've used so little. Your friend could always use a urine glucose dipstick to monitor it after the first month if she's concerned about the diabetes being less controlled.
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Date:August 1st, 2013 08:41 pm (UTC)
I inject cold all the time and haven't noticed that it was particularly uncomfortable.
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Date:August 2nd, 2013 09:58 pm (UTC)
The diabetic dog I have is on insulin as well, and bottles for him tend to last for several months (go through a bottle about every 2 months). And he gets it could and rolled, as our vet recommended. It's really helped his energy level and appetite.

I'd go with what the vet says, for reasons stated above - human things and pet things, they are not the same.