Prescription Authorization

Diabetes Mellitus is a condition that leads to very high blood sugar and eventually life-threatening complications. Insulin therapy is the most common treatment for cats and the only treatment for dogs.

Requirements for Chronic Use:
Visit with a veterinarian every 12 months.
Veterinary visit if patient is not doing well at home.
Fructosamine test 3-4 weeks after any change in insulin dosing or diet change.
Fructosamine test every 6 months.

ADDITIONAL RECOMMENDATIONS FOR CHRONIC USE:
Urine Analysis and Culture if indicated every 6 months

WHY THESE RECOMMENDATIONS ARE MADE:
Bloodwork monitoring is important after starting treatment for diabetes to ensure good control and help avoid hypoglycemia (low blood sugar) which is a medical emergency. In particular we look for: 

Is the dose of insulin appropriate and keeping blood sugar in an acceptable range?
Are there any other factors that may complicate regulation of this condition (such as dental disease or systemic illness, which can make insulin therapy less effective?)
Once your pet is on a stable management plan, diagnostics are recommended every 6 months to allow for early detection of:

Unregulated diabetes or need for dosing change or increase
Cats sometimes go into diabetic remission and may need to decrease or stop their insulin dosing.

Seek Immediate Medical Care:
If signs of hyperglycemia or hypoglycemia are present including: vomiting, lethargy, diarrhea, seizure, coma, disorientation

Chronic Kidney Disease (CKD) is a condition that decreases the kidneys ability to filter blood and regulate hydration. It is a condition that is not treated, but is managed on a long-term basis by implementing a number of methods to do the work of the kidneys for a patient as much as possible.
The following apply to patients who are doing well on the medication and have no major medical concerns.

RECOMMENDATIONS FOR CHRONIC USE:
Bloodwork:
1. Renal Panel 2-4 weeks after any change in therapy
2. HealthCheck Plus every 6 months on ongoing basis

Urinalysis +/- Urine Culutre
Blood Pressure Check

WHY THESE RECOMMENDATIONS ARE MADE:
Bloodwork monitoring is important after starting treatment for CKD to help determine if we have the appropriate management plan in place. In particular we are concerned with the following:

Have the kidney values improved any after implementing support?
Are there any electrolyte abnormalities that show up once kidney values improve?
Are there any other effects of kidney disease or causes that we need to identify to help manage?
Once your pet is on a stable management plan, diagnostics are recommended every 6 months to allow for early detection of:

Worsening kidney values that may indicate a need for further hydration support
Electrolyte imbalances requiring supplementation
Hypertension or elevated blood pressure that can hasten progression of kidney disease
Laboratory testing can help identify signs prior to a patient showing any symptoms and help guide treatment options.

Seek Immediate Medical Care:
If your pet has severe lethargy, inappetence, or vomiting

Requirements for Chronic Use:
Exam once every 12 months.

Congestive Heart Failure is a condition that results when the heart cannot pump blood effectively, and can lead to fluid buildup in the chest. It is a condition that is not treated, but is managed on a long-term basis by medication and at-home care.

The following apply to patients who are doing well on the medication and have no major medical concerns.

RECOMMENDATIONS FOR CHRONIC USE:
Visit with a Veterinarian every 6 months to do bloodwork (HealthCheck or Renal Panel) and a chest X-Ray
It is recommended to use a resting/sleeping heart rate app to track your pet's progress
Blood pressure check every 6 months

WHY THESE RECOMMENDATIONS ARE MADE:
Monitoring is important after starting treatment for CHF to help determine if we have the appropriate management plan in place. In particular we are concerned with the following:

Electrolyte imbalances that can come from medications used to treat CHF
Monitoring respiratory character and lung sounds
Once your pet is on a stable management plan, diagnostics are recommended every 6 months to allow for early detection of:

Increase in fluid buildup in the lungs that would require a change to medication
Evidence of kidney disease, which is worsened with medications used to treat CHF and can dramatically complicate medication plans
Change in heart size or structure that would indicate quickly progressing disease
Changes to blood pressure that would require additional medications
Laboratory testing can help identify signs prior to a patient showing any symptoms and help guide treatment options.

ALERT YOUR DOCTOR IF:
You notice an increase in respiratory rate or effort, resting respiration rate >30 rpm.
There is an increase in coughing, change in behavior, if the patient is cyanotic, if there is increased abdominal effort, or if there are any jugular pulses.

Requirements for Chronic Use:
Visit with a Veterinarian 1 month after starting therapy or after any dosing adjustment
Visit with a Veterinarian every 12 months ongoing
Visit with a Certified Veterinary Technician every 6 months ongoing
Renal Panel every 12 months
Chest X-Ray every 12 months