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Insulin Kinds of insulin, action profiles, use in dogs, where to buy, etc.

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  #11  
Old 11-12-2009, 01:10 PM
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Default Re: Vetsulin - FDA Warning - Schering Plough

Anyone following my thread will know how I feel....

I say try the NPH... it is working great for Sable as I have never been able to get the Vetsulin to do what the NPH does... and that is keep her numbers tight, I always had extreme highs (and some lows) on Vetsulin.

If the Vetsulin is working for you though I would stockpile (if I had Sable stay on I would stockpiled for sure ).
  #12  
Old 11-15-2009, 06:39 AM
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Default Re: Vetsulin - FDA Warning - Schering Plough

I wish the vets realized that NPH doesn't necessarily work for every dog....Soaphie had a HORRIBLE reaction to it....hence, we are HOARDING vetsulin right now and monitoring her closely.

It's really too bad this is happening.
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Soaphie = 15 yr old Border/Berner mix dx 07/08. ~8.25 units a.m./p.m. vetsulin, blind/deaf. Ultra Senior, Vital Beef/Bison, Brown Rice and lots of loving. Soaphie passed on October 29, 2015. Sydney = 14.5 yr old Aussie/Shar Pei mix dx 11/10. NPH-varies w/ predinisone a.m./p.m., blind/deaf. Sydney passed on June 3, 2014.
  #13  
Old 11-16-2009, 10:50 PM
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Default Re: Vetsulin - FDA Warning - Schering Plough

FYI: I consider this protocol flawed as it lumped cats and dogs together and asked that they all be essentially started over at a very small dose.

Richard Nelson in the Web Seminar listed later in this thread provided very different advice. He suggested cutting the dose "A few units" for dogs changing from Vetsulin to NPH because the actions of the two insulins in dogs are typically so similar.

We have been recommending cutting the dose about 20-25% and after seeing a dozen dogs go through the transition, 10-15% percent might be okay.

Natalie

AAHA Recommended Protocol for Transitioning Dogs Off of Vetsulin
http://www.aahanet.org/resources/gra...n_11-16-09.pdf

Quote:
Dr. Richard Nelson of the University of California at Davis, and Drs. Deb Zoran and Audrey Cook of Texas A&M University, expert veterinary members of the AAHA Diabetes Guidelines Task Force, have developed and approved the following recommendations on how to transition your diabetic patients:

For dogs, use the human recombinant NPH insulin at an initial dosage of 0.25 IU/kg twice daily, and adjust insulin based on clinical response and glucose measurements. You will be starting over with diabetic regulation when you switch to a new insulin product.
Quote:
In addition to transitioning from Vetsulin, veterinarians need to be vigilant about using the appropriate syringe for the new insulin for each pet. This is necessary to ensure that patients receive the proper dosage of the new insulin product.

We hope that these recommendations will be useful for you when considering how to approach this situation with your diabetic patients. We encourage you to report any adverse event with the Vetsulin product to Intervet/Schering-Plough Animal Healthís technical services department at 800/224-5318.The American Animal Hospital Association will post updated information about the alert to www.aahanet.org as it becomes available.
Thank you Sophia Yin for the heads-up on this protocol announcement.

Natalie
  #14  
Old 11-19-2009, 08:43 PM
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Default Re: Vetsulin - FDA Warning - AAHA Protocol to Switch to NPH

I would hold onto any Vetsulin you have until your dog has successfully switched to NPH and you find that it's working well. If it isn't working well, you will be glad you have the Vetsulin vials.

We went through the discontinuation of Humulin L about four years ago. There were a handful of dogs who could stay well regulated only if if they stayed on Humulin L and those folks stockpiled as much Humulin L as they could get their hands on - scoured every local pharmacy and shared what they had with others in the same boat. I know some of those dogs managed to accumulate enough Humulin L to last a couple of years.

I don't know how much supply is out floating around of Vetsulin. Humulin L was still being used by people so it had a larger market. But I'd say it's worth holding onto any that you do have at least until you find out whether NPH is a good match for your dog.

Natalie
  #15  
Old 11-21-2009, 04:48 PM
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Default Re: Vetsulin - FDA Warning - Schering Plough

http://www.aahanet.org/education/wc_vetsulinupdate.aspx fyi. a webinar Tuesday the 24th on Vetsulin by AAHA
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  #16  
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
  #17  
Old 11-30-2009, 08:02 PM
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Default Re: Vetsulin - FDA Warning - AAHA Protocol for Change to NPH

I heard from a member today who said she got an email from 1-800-PetMeds that Vetsulin will not be available from them 3-4 weeks from now.

Natalie
  #18  
Old 01-24-2010, 10:29 AM
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Default Re: Vetsulin - FDA Warning - AAHA Protocol for Change to NPH

Thank you Eileen for bringing the newest Intervet letter regarding supplies of Vetsulin to our attention!

Quote:
January 8, 2010

Re: Transition Assistance Via Independent Phone Consultation

Dear Doctor:

We appreciate all your efforts in transitioning your diabetic patients currently on Vetsulinģ (porcine insulin zinc suspension) to other insulin products. As discussed in our letter dated November 30, 2009, it is imperative that you transition all of your diabetic patients off of Vetsulin as future supplies of Vetsulin will be very limited in early 2010, and then exhausted.

Intervet/Schering-Plough Animal Health has worked with expert members of the AAHA Diabetes Guidelines Task Force and provided information on transitioning dogs and cats from Vetsulin to other insulin products (see links to these documents below). However, we have received calls from some concerned veterinarians who are still encountering difficulties despite having followed these recommendations. Therefore, we would like to offer assistance to two specific categories:
  1. Where there are still difficulties in re-regulating patients on other insulin products;
  2. Where a veterinarian had initially prescribed Vetsulin because other insulin products had been ineffective in regulating their patient.
In order to assist with these specific patient categories, Intervet/Schering-Plough Animal Health has contracted with Thomas K.Graves, DVM, PhD, DACVIM and his staff at the University of Illinois, College of Veterinary Medicine, to provide independent telephone consultations on these difficult cases.

Please note that Intervet/Schering-Plough Animal Health is making this service available as a patient courtesy. Dr. Graves will be acting as an independent consulting veterinarian, and Intervet/Schering-Plough Animal Health does not guarantee or warrant that the consultation will lead to a successful resolution of these cases. Intervet/Schering-Plough Animal Health will not bear any responsibility for the outcomes of these cases.

If you have a patient that falls into either of the two categories mentioned above, please contact Intervet/Schering-Plough Animal Health technical services at 1-800-224-5318 to discuss if the case qualifies for a telephone consultation with either Dr. Graves or one of his board certified internists.

The costs associated with the telephone consultations organized by our technical services veterinarians will be covered by Intervet/Schering-Plough Animal Health. Any cost incurred as a result of the consultation, including, but not limited to, additional veterinary fees, recommended additional diagnostic tests or additional medications, will not be covered by this program.

Thank you for your cooperation and efforts to transition diabetic patients off of Vetsulin and onto other insulin products.

Sincerely,

Christopher Pappas, Jr., DVM
Director, Companion Animal Technical Services
Intervet/Schering-Plough Animal Health
http://vetsulin.com/vet/Vet_ProductAlert.aspx
  #19  
Old 05-06-2010, 06:29 AM
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Default Vetsulin Sales Prohibited - FDA Warning - Dogs Changing to NPH

This announcement was made yesterday (5/5/2010) by the fda. Thought it may be of interest to some.

http://tinyurl.com/24gq3ef

Quote:
FDA Announces Availability of Vetsulin for Critical Needs Dogs and Cats
May 5, 2010

The Food and Drug Administration (FDA) announced today a plan to address concerns regarding the supply of Intervet/Schering Plough Animal Healthís (Intervet) Vetsulin (porcine insulin zinc suspension), a product used to treat diabetes in dogs and cats. FDA is allowing Intervet to offer a limited supply of Vetsulin through their Vetsulin Critical-Need Program. The supply is only to be used for a critical-need dog or cat that, in the medical judgment of the petís veterinarian, cannot be effectively managed on another insulin product.

In November 2009, FDA announced its concerns about the stability of Vetsulin and recommended that diabetic dogs and cats currently receiving Vetsulin be switched to other insulin products. After publicizing this recommendation, FDA and Intervet heard from many veterinarians and pet owners who expressed significant concerns about specific diabetic dogs and cats which could only be controlled with Vetsulin.

As a result of these concerns, FDA is recommending veterinarians with qualified patients contact Intervetís Technical Services Department at 800-224-5318, to request enrollment of the patient in the Vetsulin Critical-Need Program. The veterinarian will need to provide the medical rationale for why the patient cannot be effectively controlled using another insulin product.

Intervet continues to work with FDA to address concerns associated with the manufacture of Vetsulin. Because Vetsulin may have varying amounts of crystalline zinc insulin in the formulation, it could cause a delay in insulin action and an overall longer duration of insulin activity. Insulin products that do not remain within specification throughout the entire shelf life could potentially result in unpredictable fluctuations in the glucose levels of diabetic patients.

Use of this product under the Critical-Need Program will require close monitoring of the patient, all of which is described in an owner consent form.
Eileen/Mildred
  #20  
Old 05-15-2010, 11:34 AM
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Default Re: Vetsulin Sales Prohibited - FDA Warning - Dogs Changing to NPH

Web seminar on changing dogs and cats from Vetsulin, with dogs recommended changed to NPH:

http://www.aahanet.org/education/wc_vetsulinupdate.aspx
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