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Old 11-24-2009, 12:13 PM
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Default Vetsulin - FDA Warning - AAHA Protocol for Change to NPH

I just finished listening to the web conference on changing insulins. Most of it was about what I expected and what we have talked about here.

Dr. Nelson addressed dogs and his feeling was that NPH is readily available, has a similar duration and action as Vetsulin, and has decades of successful use so it makes sense for that to be the insulin to switch to.

[NOTE: The following was stated BEFORE Intervet released a second letter on November 30 strongly stressing that all patients should be switched to a different insulin product because of anticipated supply shortages, which are already starting to show up in the third week of January.]He does not recommend switching if your dog is doing really really well on Vetsulin, at least until lack of supply makes it necessary if it comes to that.

He has not had much success with either Lantus or Detemir but he also makes note that he doesn't see dogs who are just starting insulin. He only sees dogs who are having problems so that may skew his results.

He said he has sometimes had success using Detemir in combination with Regular insulin as the response to the Detemir was apparently a pretty flat basal type response. But he says he doesn't like having to use two insulins at the same time because it decreases owners' willingness to keep up the treatment.

His goal for a well regulated dog is blood sugar mostly between 80 and 300 with an average for the day of 250 or less.

His recommendation for a starting dose when switching to NPH is to cut the dose "a few units" - from the examples he gave, he would reduce the dose about 20%, for all the reasons we have discussed... the insulin action may be different so best to start on the low end and work up.

One interesting new insulin is the new PZI - ProZinc.

The old PZI was not recommended for dogs because it contained mostly beef-derived insulin and generated a lot of resistance in dogs. That insulin is being discontinued and ProZinc is just being released. It is human-type insulin, like NPH and Lantus.

It remains to be seen how dogs will do on it. Generally, if the insulin action is slowed down too much, dogs haven't gotten a very good response. Ultralente was another long-acting insulin that, used by itself, generally did not work well. So it's hard to say if PZI, now that it's human insulin, which usually works well with dogs, will have a good effect in the protamine zinc formulation.

Natalie