Sources for Insulin?

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Jennifer Thompson - 18 Oct 2003 01:41 GMT

Hi all,

I just purchased my first vial of PZI insulin from my vet, for my
newly-diagnosed diabetic cat, Sylvester. The vial will last just under
two months, at his current dose of 4 units a day, which will probably be
increased to somewhere between 8 and 14 units a day, based on my vet's
past experience with cats Sylvester's size (17 pounds). That will mean
I will be going through at least a vial a month.

The vial cost $130.00!

The vet told me he would write me a prescription if I found the same
insulin somewhere else, for less.

Does anybody here know of an on-line pharmacy or somewhere else I can
get this type of insulin less expensively?

Thanks,
Jennifer

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Marek Williams - 18 Oct 2003 05:56 GMT

>Does anybody here know of an on-line pharmacy or somewhere else I can
>get this type of insulin less expensively?

Yikes!

In the U.S. human insulin costs about $25-30 per 1000 unit vial (10
ml, U-100). I don't know anything about PZI insulin, but my initial
reaction is that it shouldn't cost anywhere near that amount.

Having said that, almost all human insulin is made from e. coli
bacteria which have been genetically reengineered to produce human
insulin. In the olden days it was made by processing the pancreases
from pigs and cows, and it was more expensive back then. I'm wondering
if the demand for PZI insulin is so low that they have to use older,
more expensive methods to make it.

--
Bogus e-mail address, but I read this newsgroup regularly, so reply here.

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Karen - 18 Oct 2003 07:37 GMT

>> Does anybody here know of an on-line pharmacy or somewhere else I can
>> get this type of insulin less expensively?
[quoted text clipped - 14 lines]
> --
> Bogus e-mail address, but I read this newsgroup regularly, so reply here.

you might go to a local pharmacist. They will know what it is, how much it
is and might be able to supply it at a lower price.

Karen

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Magic Mood Jeep? - 18 Oct 2003 08:03 GMT

from WebMD's Glossary of Diabetes related terms:

protamine zinc insulin (PZI)-A long-acting insulin, prepared with large
amounts of protamine combined with Regular insulin in the presence of zinc.

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> >> Does anybody here know of an on-line pharmacy or somewhere else I can
> >> get this type of insulin less expensively?
[quoted text clipped - 19 lines]
>
> Karen

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Phil P. - 18 Oct 2003 10:40 GMT

> Hi all,
>
> I just purchased my first vial of PZI insulin from my vet, for my
> newly-diagnosed diabetic cat, Sylvester. The vial will last just under
> two months, at his current dose of 4 units a day, which will probably be
> increased to somewhere between 8 and 14 units a day, based on my vet's >

past experience with cats Sylvester's size (17 pounds). That will mean

> I will be going through at least a vial a month.

I'm a little surprised your vet started right off with PZI - we only use PZI
in cats that are difficult to regulate with lente or ultralente insulin -
which isn't that many cats - even though human insulin is completely
different than feline insulin.

> The vial cost $130.00!

I paid about $700... for *twelve* vials of U40 PZI... and that's without a
discount. That breaks down to about $60 a vial... They have (had) an
minimum order of 3 vials which still cost less than $200.

> The vet told me he would write me a prescription if I found the same
> insulin somewhere else, for less.

Not a good idea - see below.

> Does anybody here know of an on-line pharmacy or somewhere else I can
> get this type of insulin less expensively?

Jennifer, you're treading on dangerous ground with PZI. There's only *one*
reliable source for PZI and that's:

Blue Ridge Pharmaceuticals
4249-105 Piedmont Parkway
Greensboro NC 27410

You can call BRP for a quote at 1-800-374-8006 - but they'll only sell to
vets. They're very helpful and will answer all your and your vet's
questions.

BRP is rhe only manufacturer of PZI that is applying for FDA approval
specifically for cats. This means BRP PZI is manufactured under FDA drug
policies. Its also the only insulin that's manufactured in large quantities
and tested *specifically* for cats.. Large production runs significantly
reduces variations from vial to vial.

PZI can be compounded by any compounding parmacist... However, its very
difficult to maintain consistency in drugs manufactured in small quantities
and by different people. IOW, every new vial of compounded PZI can be a
crap-shoot - with unpredictable results.

I strongly advise you buy your PZI *only* from Blue Ridge Pharmaceuticals.

Good luck.

Phil.

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Nancy Thuleen - 18 Oct 2003 16:34 GMT

> I paid about $700... for *twelve* vials of U40 PZI... and that's without a
> discount. That breaks down to about $60 a vial... They have (had) an
> minimum order of 3 vials which still cost less than $200.

Yes, that's exactly what I pay (through my vet): about $63 per bottle,
I usually get them in batches of 3 bottles, occasionally four if my
schedule looks crowded. They do send syringes with that, so no cost
for those, at least, but it is an expensive insulin.

I can only agree with *everything* Phil said about PZI. I don't like
the cost, but after spending 8 months trying Ultralente, Lente and even
N human insulin, NONE of which were working for Kelson, we switched to
PZI and within a week he was almost completely regulated. But I know
that for a lot of cats, Ultralente or Lente work great, and they're
about 1/3 of the price of PZI -- and you can get them from any local
pharmacy, since they're just the standard Lilly insulins that people
use.

> PZI can be compounded by any compounding parmacist... However, its very
> difficult to maintain consistency in drugs manufactured in small quantities
> and by different people. IOW, every new vial of compounded PZI can be a
> crap-shoot - with unpredictable results.

One time my vet had a new person in charge of placing orders, and
instead of going through Blue Ridge she went through a local
compounding pharmacy. It cost about $10 less per vial, but it was
HORRIBLE insulin -- Kelson immediately starting rebounding from going
too low, and when I cut the dose by only .5 units, he ended up staying
over 400 all day, so within a week I returned those bottles (the vet
absorbed the cost, THANKFULLY) and got back to Blue Ridge's PZI, and
all was fine again. Never again! I always make sure it's Blue Ridge
before I pay for it now.

To the original poster who was planning on using about a vial a month
-- that's probably about all you can use. Once it's opened, insulin
starts to lose its effectiveness, even in the refrigerator. It's a
slow loss, and the first two weeks don't seem to show any differences
for Kelson, but after exactly 23 days for Kelson, I can't really use
the bottle anymore. However, that could be because the vial is getting
very low and more air is in it, so it may last longer if it stays
fuller, I don't know.

> BRP is rhe only manufacturer of PZI that is applying for FDA approval
> specifically for cats.

I could be wrong, but I thought they got FDA approval a few months ago.
The first time I bought PZI, I had to sign a consent form, and my vet
had to agree to keep records and allow visitation for testing purposes.
(My vet said, "if the FDA shows up on my doorstep, it's your fault,
Nancy!" But she was laughing.) A few months later they apparently
told my vet that she didn't need to keep records anymore, that they had
passed the approval testing stage. But I don't know what real
difference that makes.

Anyway, even though I love PZI for its effectiveness, I do grumble at
the cost, and I'd strongly advise Jennifer to talk to her vet about
trying Ultralente or Lente insulin first. (Remember to use the correct
syringes if you switch! PZI uses U-40 syringes, human insulin uses
U-100 -- a 2.5x difference, so you could have real problems if you used
the wrong syringes!)

Good luck!
- Nancy.

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Phil P. - 20 Oct 2003 00:59 GMT

> > I paid about $700... for *twelve* vials of U40 PZI... and that's without a
> > discount. That breaks down to about $60 a vial... They have (had) an
[quoted text clipped - 28 lines]
> all was fine again. Never again! I always make sure it's Blue Ridge
> before I pay for it now.

Hi Nancy,

I was thinking about what you said, let me know if this makes sense to
you...

BRP PZI is beef-pork insulin - beef insulin is only one amino acid off from
feline insulin and pork insulin is off by three. However, human insulin is
off by all four. An abrupt change in insulin types and especially species,
would produce drastic and absolutely unpredictible results.otamine-zinc

Unless the pharmacy has *many* customers that order PZI on a regular basis,
I can't imagine how or from whom a pharmacy can order such a small quantity
of beef-pork or pork insulin to compound with protamine-zinc for only one or
two cats. My guess for why you experienced such terrible results with the
compounded PZI is because the pharmacist compounded *human* insulin with
protamine-zinc. That would also explain the cheaper cost.

Whaddaya think?

Phil

> To the original poster who was planning on using about a vial a month
> -- that's probably about all you can use. Once it's opened, insulin
[quoted text clipped - 26 lines]
> Good luck!
> - Nancy.

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Nancy Thuleen - 20 Oct 2003 02:29 GMT

> My guess for why you experienced such terrible results with the
> compounded PZI is because the pharmacist compounded *human* insulin with
> protamine-zinc. That would also explain the cheaper cost.
>
> Whaddaya think?

I did know about the pork-beef versus human issue, but didn't really
think about the possible effects. You're probably right -- every human
insulin that we tried with Kelson (all the Lilly ones except the
fast-acting ones like R) just were NOT effective -- they either didn't
do a thing, or they caused him to swing unpredictably high and low at
very random times (it wasn't rebound, just unpredictable absorbtion of
the insulin). That never happens with the PZI, and it's probably, like
you said, due to the species difference.

I know my vet called the compounding pharmacy on that bad insulin to
make sure it was protamine-zinc (it was), but I just don't recall
whether she asked or mentioned any species difference. It was almost a
year ago now, so I probably wouldn't remember anyway. At any rate,
Kelson's doing very well on Blue Ridge PZI, and as long as my wallet
doesn't give out, we'll stay with this. I just hope they don't go out
of business, since I don't ever want to go back to those unpredictable
absorbtion days!

Thanks for the input, Phil.
- Nancy.

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Jennifer Thompson - 20 Oct 2003 19:11 GMT

> > My guess for why you experienced such terrible results with the
> > compounded PZI is because the pharmacist compounded *human* insulin with
[quoted text clipped - 22 lines]
> Thanks for the input, Phil.
> - Nancy.

OP here, and I just wanted to say thanks again for all the info on the PZI.
Not only do I now know how RIPPED OFF I got at $130 a vial, but I will also
make sure to only get it from Blue Ridge. The vial I have now is not from
Blue Ridge - it's some other company...alas, it's at home and I'm at work and
I cannot recall the name! I want to say something like "Activex" or something
similar.....

Anyway, I moved over the weekend, which means that Sylvester's care will be
transferred to a different vet (his old vet, since I moved back to the same
area that I lived before). I will go over all of this stuff with him...human
vs. beef-pork insulin, etc. and if he agrees that keeping him on the PZI is
the way to go, I'll ask him about ordering for me from Blue Ridge.

So far, Sylvester seems fine. His peeing has reduced quite a bit. He still
urinates a bit more than my other cat, but it is nowhere the flood that I was
cleaning out every day, so it appears that the insulin is indeed making a
difference.

We'll know more when I take him to the new (old) vet for the fructosamine
test.

Thanks again, everybody.

Jennifer

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Nancy Thuleen - 20 Oct 2003 20:42 GMT

> OP here, and I just wanted to say thanks again for all the info on the PZI.
> Not only do I now know how RIPPED OFF I got at $130 a vial, but I will also
> make sure to only get it from Blue Ridge. The vial I have now is not from
> Blue Ridge - it's some other company...alas, it's at home and I'm at work and
> I cannot recall the name! I want to say something like "Activex" or something
> similar.....

IDEXX, I bet. Actually, that *is* Blue Ridge -- they're a subsidiary
of the Idexx corporation. A few months ago my Blue Ridge bottles
stopped saying "Blue Ridge" on them, but the syringes and invoice still
say Blue Ridge, and the older insulin vials used to say "Blue Ridge
Pharmaceuticals, a subsidiary of the Idexx corporation". So you are
getting Blue Ridge, just at twice the cost that most of us pay. :)

Good luck with the vet switch, and keep us updated!
- Nancy.

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Jennifer Thompson - 20 Oct 2003 21:27 GMT

> > make sure to only get it from Blue Ridge. The vial I have now is not from
> > Blue Ridge - it's some other company...alas, it's at home and I'm at work and
[quoted text clipped - 10 lines]
> Good luck with the vet switch, and keep us updated!
> - Nancy.

YES! That's it! Idexx! Well, at least I feel better knowing I paid top dollar for
the "good" stuff. I was starting to worry that he wasn't getting the best stuff.

Hopefully the other vet we will have to now see will get the Idexx stuff too, and
just pass his cost on to me, rather than doubling it to make a big profit. Sheesh.

Will keep y'all posted on how we do.

Jennifer

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