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

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  #1  
Old 11-02-2009, 05:37 PM
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Exclamation Summary of Information on Changing from Vetsulin to NPH

http://www.fda.gov/AnimalVeterinary/.../ucm188752.htm
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Old 11-02-2009, 06:06 PM
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Default Re: Vetsulin - FDA Warning

Quote:
FDA’s Center for Veterinary Medicine Alerts Veterinarians About Problems with Vetsulin® to Treat Diabetes in Dogs and Cats

November 2, 2009

The Food and Drug Administration’s (FDA) Center for Veterinary Medicine (CVM) and Intervet/Schering-Plough Animal Health are alerting veterinarians and pet owners that Vetsulin®, a porcine insulin zinc suspension used to treat diabetes in animals, may have varying amounts of crystalline zinc insulin in the formulation. Because this Intervet/Schering-Plough Animal Health product is out of specification it could cause a delay in insulin action and an overall longer duration of insulin activity. Products having significant problems with stability can affect the management of chronic diseases. Unstable insulin products can result in unpredictable fluctuations in the glucose levels of diabetic patients. Intervet/Schering-Plough Animal Health is unable to assure FDA that each batch of their product is stable.

FDA and Intervet/Schering-Plough Animal Health request that veterinarians closely monitor their patients receiving Vetsulin® for any changes in onset or duration of activity, or for any signs of hyperglycemia or hypoglycemia. The classic signs of hyperglycemia include increased thirst, increased urination, weight loss and lethargy. The classic signs of hypoglycemia would include disorientation, unsteadiness, weakness, lethargy, and seizures.

While Intervet/Schering-Plough is working with FDA on resolving this issue, supplies may be limited. Therefore, veterinarians should consider transitioning their diabetic patients to other insulin products. In addition, FDA encourages veterinarians to report any adverse events with the Intervet/Schering-Plough Animal Health product to the company through the Technical Services Department at 1-800-224-5318.
Yikes! No lot numbers or dates offered as to when this seems to have occurred.

Thank you Ann for posting this!

Anyone here using Vetsulin seeing any problems?

Natalie
  #3  
Old 11-03-2009, 07:55 PM
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Default Re: Vetsulin - FDA Warning

In checking your dog while still on Vetsulin and deciding what to do, it's probably worth pointing out that the problem should be variance between bottles, not between various injections from one bottle.

Let's say just for argument's sake that one bottle has 75% ultralente and another bottle has 65%. All of the injections from the first bottle would deliver 75% ultralente crystals so any variations you see while using a single bottle of insulin most likely come from other factors. All of the injections from the next bottle would deliver less, 65% ultralente.

If you see a change in the insulin response when you start another bottle, that could very well be the issue that FDA is warning about. For those starting to see hypoglycemia after starting a new bottle of insulin, it's conceivable that there is extra ultralente or that there is relatively more shorter-acting insulin.

At least that's what I can deduce from the announcement... not that there is a flaw with the crystals themselves but that there is a variance in the amount of crystals in each bottle.

So in theory you could use a stockpile recently purchased but would have to be very careful when starting a new bottle and perhaps even drop the dose slightly until you have a chance to see how the new bottle seems to work for your dog.

Each time a new bottle is opened, you would have to consider that it might be different than the last one.

The lack of supply is almost the bigger issue. I don't know how much vets have stockpiled the insulin... it has seemed in the past when there were some brief supply shortages that they don't necessarily keep a lot of it around. Folks with only one bottle could have a serious problem.

I think it's worth talking to the vet now about obtaining a few months worth of insulin if you plan to stay on Vetsulin or even just want some time to think it over... and especially if, like Soaphie, NPH is not an option.

Tami, I think Soaphie can stay on Vetsulin if you can obtain some bottles of it. I know you would test and adjust as needed.

I'm not so worried about folks who home test blood sugar, more about the ones who don't and the ones who don't monitor much of anything. And about the ability to get insulin at all.

Several times over the past four years we have seen bouts of dogs on Caninsulin or Vetsulin who sudden lost regulation and we have speculated that there may be production problems at those times that have altered the makeup of the insulin. The perceived problems were essentially what I would think would happen here - that new bottles of insulin seemed to have a different amount of kick than previous ones.

Natalie
  #4  
Old 11-04-2009, 12:25 PM
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Default Re: Vetsulin - FDA Warning

I just spoke to the vet at Schering Plough. First there is no time line developed for a fix. It could be months. It affects Vetsulin and Caninsulin. It's a global issue.

Natalies assumption is correct. It does NOT affect the short acting portion of the insulin. It does affect the longer acting portion where the affect could be STRONGER or LONGER, so its really important to make sure that your dogs lowest point is ok and also that its affect is completed before you give them their next shot if you are going to stay with this insulin.

She agreed that if you are seeing no difference after several injections from a new bottle that it was not affected by this problem. It will be consistent with the vial.

She also emphasized that is very very important to make sure you do a good job suspending/mixing the insuling before drawing, being more cautious than ever.

She didn't say but she was clearly concerned that people understand these points if they weren't switching to a new insulin.
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  #5  
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 ).
  #6  
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.
  #7  
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 Health’s 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
  #8  
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
  #9  
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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  #10  
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 Vetsulin® (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
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