Caninsulin Diabetes
Stabilisation Protocol
This information is supplementary to the summary of product characteristics. All other product information should be read in conjunction with the protocol.
STEP 1
DIAGNOSIS OF DIABETES MELLITUS
STEP 2
CANINSULIN TREATMENT
Caninsulin VetPen
ESTABLISHING A STARTING DOSE
CATS: Initial dosing is 1IU or 2IU per injection based on the below baseline blood glucose. All cats require
Caninsulin twice daily (see over for feeding advice).
Cat blood glucose concentration
Starting dose per cat
<20 mmol/l or < 3.6 g/l (<360mg/dl)
1 IU twice daily
>20 mmol/l or > 3.6 g/l (>360mg/dl)
2 IU twice daily
DOGS: In studies conducted with Caninsulin, 0.5 to 1.0 IU/kg bodyweight once daily has been shown to be an
appropriate starting dose. The duration of insulin action as determined by a blood glucose curve may require
twice daily dosing. In such cases, the dose per injection should be decreased by 25% so the total daily dose is
less than doubled. Dosing should be twelve hours apart (see over for feeding advice).
Twice daily administration of Caninsulin is often recommended by UK experts as best practice as it
appears to offer improved glycaemic control over insulin administered once daily1,2,3,4,6. An appropriate
starting dose for dogs receiving Caninsulin twice daily would be 0.25-0.5 IU/kg1,5,6,7.
Carefully monitor on first day of treatment for signs of hypoglycaemia and assess initial response to insulin.
MAINTAIN INITIAL DOSE (UNCHANGED) FOR 7-21 DAYS
This will allow time for the animal’s blood glucose levels to reach a steady state. Do not alter the dose more frequently
than every 3 days in dogs and 7 days in cats8. Establish owner routine: www.mypetonline.co.uk/petdiabetes
PLOT BLOOD GLUCOSE CURVE
Use a new vial of Caninsulin and ensure dose is administered by vet/nurse. Hospitalise animal and sample every 2
hours for at least 12 hours. In cats, consider home blood glucose curves plotted by owner using ear-prick sampling.
STEP 3
ADJUST DOSE
Use small incremental adjustments of 1 IU per injection for cats. Dose adjustments of approximately 10% per
injection are appropriate for dogs.
STEP 4
ALLOW 7 DAYS AFTER EACH DOSE ADJUSTMENT
This will allow time for the animal’s blood glucose levels to reach a steady state after a dose adjustment and is a
convenient practical interval. Do not alter the dose more frequently that every 3 days in dogs and 7 days in cats8.
STEP 5
REASSESS THE ANIMAL
This may not require a full blood glucose curve every time the pet is seen. A few samples taken around the expected
nadir (aiming for 6-9mmol/l) may suffice in conjunction with clinical signs.
STEP 6
REPEAT STEPS 3-5 UNTIL THE ANIMAL IS STABLE
Aim primarily for clinical stability - resolution of clinical signs - which usually indicates good glycaemic control.
STEP 7
LONG TERM MONITORING
Owner to monitor weight, appetite, drinking and general demeanour. Follow up examinations every 2-4 months are
advised to monitor the animal’s health, the owner’s records and to assess the animal’s biochemical parameters (such
as blood glucose and fructosamine).
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Simplifying small animal diabetes
FEEDING
DOGS:
• Once daily dosing: Feed half the daily meal at time of insulin injection and feed other half at
peak insulin activity which occurs in dogs between 4-8 hours post subcutaneous injection.
• Twice daily dosing: Feed half the daily meal to coincide with the first injection and the other
half of the meal with the subsequent injection (12 hours later).
CATS:
• Allow cats to eat as they are accustomed.
Rewriting pet diabetes management
For more information on Caninsulin or to download a printable version of this form visit www.caninsulin.co.uk
REFERENCES
1. Feldman EC, Nelson RW. Canine Diabetes Mellitus. In, Canine and Feline Endocrinology and Reproduction, 3rd Edition, Eds EC Feldman, RW Nelson, Saunder. 2004.
pp. 499.
2. Davison LJ, Herrtage ME, Catchpole B. Study of 253 dogs in the United Kingdom with Diabetes Mellitus. Veterinary Record. 2005; 156:467-471.
3. Monroe WE, et al. Efficacy and Safety of a Purified Porcine Insulin Zinc Suspension for Managing Diabetes Mellitus in Dogs. Journal of Veterinary Internal Medicine.
2005; 19:675-682.
4. Graham PA, Nash AS, McKellar QA. Pharmacokinetics of a porcine insulin zinc suspension in diabetic dogs. Journal of Small Animal Practice. 1997; 38:434-438.
5. Church DB. Drugs used in the treatment of disorders of pancreatic function. In, Small Animal Clinical Pharmacology, 2nd Edition, Eds J Maddison, SW Page, D Church,
Saunders Elsevier, 2008, pp. 509-516.
6. Nelson RW. Chapter 6: Canine diabetes mellitus. In, BSAVA Manual of Canine and Feline Endocrinology, 3rd Edition, Eds RW Nelson, CT Mooney, ME Peterson.
BSAVA, UK, 2004. pp. 112-128.
7. Watson PJ. Chapter 52: Disorders of the endocrine pancreas. In, Small Animal Internal Medicine, 5th Edition, Eds RW Nelson, CG Couto. Saunders Elsevier, 2013. pp.
777-823.
8. Caninsulin Summary of Product Characteristics.
9. Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy.
Journal of Feline Medicine and Surgery. 2001;3:23-30.
10. Martin GJ, Rand JS. Control of diabetes mellitus in cats with porcine insulin zinc suspension. Veterinary Record 2007;161:88-94.
11. Brianceau P., Chester T., Smith A., et al. Efficacy and safety of porcine insulin zinc suspension (IZS-P) for reducing hyperglycemia and associated clinical signs in cats with
diabetes mellitus. 22nd ACVIM Forum San Antonio, Texas, 4-7 June, 2008.
12. Michiels L., Reusch C.E., Boari A., et al. Treatment of 46 cats with porcine lente insulin – a prospective, multicentre study. J Feline Med Surg., 2008 10(5): 439-451.
13. Zini E., Hafner M., Osto M., Franchini M., et al. Predictors of clinical remission in cats with diabetes mellitus. J Vet Intern Med., 2010. 24(6):1314-1321.
14. Davison L.J, Ristic J.M.E, Herrtage M.E, Ramsey I.K and Catchpole B. Anti-Insulin Antibodies in Diabetic Dogs Treated With Two Different Insulin Preparations.
Proceedings 12th ECVIM-CA/ESVIM Congress, 19-21 September 2002, Munich Germany, J Vet Int Med 16(5):636-637.
15. Adams JP, Catchpole B. Prevalence of anti-insulin antibodies in insulin-treated diabetic cats. In, Proceedings BSAVA Congress, 3-6 April 2008. pp. 486-487.
16. Burgaud, S., Riant, S., Piau, N. Comparative laboratory evaluation of dose delivery using a veterinary insulin injection pen. Congress of the BSAVA and WSAVA. 12-15
April 2012, Birmingham, United Kingdom.
Contra-indications, warnings etc
The product must not be administered by the intravenous route. The product is a medium duration insulin and is not intended for the treatment of animals with severe acute
diabetes presenting in a ketoacidotic state. In the cat diabetic remission is possible.Before the product is administered owners should be instructed to have a box of powdered
glucose at home. Signs of hunger, increasing anxiety, unstable locomotion, muscle twitching, stumbling or sinking in the rear legs and disorientation indicate progression
of hypoglycaemia and requires immediate administration of glucose solution and food to restore blood glucose levels. Polyuria, polydipsia and polyphagia in combination
in chronic cases with weight loss, general bad condition, loss of hair or abnormal furry coat and lethargy are the most common clinical symptoms of hyperglycaemia and
require administration of insulin to restore blood glucose levels to the normal range. The use of progestagens (oestrus inhibitors) in patients suffering from diabetes mellitus
should be avoided. Stress and irregular extra exercise must be avoided. Care must be taken with the use of corticosteroids. Ovariohysterectomy may have to be considered.
It is important to establish a strict feeding schedule in consultation with the owner which will include a minimum of fluctuations and changes. Administration of the product
must be carried out by an adult responsible for the welfare of the animal.The product must be administered with specific IU40 sterile single-use syringes (vial) or with VetPen
(cartridge).Accidental self-injection can provoke clinical signs of hypoglycaemia and there is a low possibility of an allergic reaction. In case of accidental self-injection seek
medical advice immediately and show the package insert to the doctor. In the unlikely event or accidental eye and skin contact, wash the area with clean, running water. Local
injection site reactions have been reported rarely in dogs and very rarely in cats. These reactions are usually mild and reversible. In very rare cases, allergic reactions to porcine
insulin have been reported.The use of the product is not contra-indicated during pregnancy or lactation but requires close veterinary supervision to account for changes in
metabolic requirements during this period. Changes in insulin requirements may result from administration of substances which alter glucose tolerance, such as corticosteroids,
thiazide diuretics, progestogens, amitraz and alpha-2 agonists, such as medetomidine, dexmedetomidine, xylazine. Monitoring of glucose concentrations should be used to
adjust the dose accordingly. Similarly, changes in diet or exercise may alter insulin requirements.
For animal treatment only. Keep out of reach of children. Legal category POM-V
Caninsulin is property of Intervet International B.V. or affiliated companies
or licensors and is protected by copyrights, trademark and other intellectual
property laws. Copyright (c) 2014 Intervet International B.V. All rights reserved.
For further information about Caninsulin VetPen, please contact our
Technical Product Support Team on 01908 685685
or [email protected]
MSD Animal Health, Walton Manor, Walton, Milton Keynes MK7 7AJ
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SA-046914 • 63109/DEC14/NB/4K
Caninsulin is indicated for the treatment of diabetes mellitus in cats and dogs.
Caninsulin is an intermediate acting insulin product containing porcine insulin, which is structurally identical to canine insulin.
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