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-   -   Switching to NPH - question on process (http://k9diabetes.com/forum/showthread.php?t=2265)

marydog 11-07-2010 11:21 PM

Switching to NPH - question on process
We are going in the middle of this week to switch Mary, 12 years old from Caninsulin to NPH. She was diagnosed with diabetis in July 2009. Right now we are giving her 8 units of Caninsulin. Vet told don't give Mary Caninsulin for 2 days (to shake off Caninsulin) and then start with 9 units of NPH. I'm afraid do not give her insulin for 2 days and another concern is about 9 units. I read that dose of NPH should be lower then Caninsulin dose. Would somebody give me other opinions or share own experience. Thank you.

BestBuddy 11-07-2010 11:38 PM

Re: Switching from Vetsulin to NPH
Hi Marydog,

My Buddy changed from Caninsulin to NPH. He was on 4.8iu of Caninsulin (marker 12 in U100 syringe) and we used Caninsulin one day and the next day (normal injection time) gave 4iu of NPH.

Buddy had been diabetic for many years and we felt confident that we could check his reaction so didn't reduce the amount much to start. Many start 25% lower just to be safe. I'm not sure I agree stopping insulin for so long before starting NPH because those BG numbers will just keep rising and make it that much harder.

Make sure you have the right syringes for the insulin.


AlisonandMia 11-08-2010 12:14 AM

Re: Switching from Vetsulin to NPH
I share your concerns about what is in effect not treating the diabetes for two days - this could result in diabetic ketoacidosis which can be fatal or at least very unpleasant for the dog and expensive for the owner to treat. I don't believe any type of "washout" between the two types of insulin is needed or recommended.

Dogs are typically transitioned from Vetsulin/Caninsulin to NPH by simply giving the last dose of Vetsulin in the evening one day and starting the NPH the next day. Most dogs seem to end up on the same number of units per dose of NPH as they were having of the Vetsulin but just be on the safe side it has been recommended that you start the NPH at a dose about 25% lower than the dose of Vetsulin and then work your way up as necessary.

The most important thing in the transition though is to make sure you have the right syringes. Vetsulin is more dilute than NPH so it is vital that the correct syringes are used with NPH - otherwise you risk inadvertently od'ing! With NPH you need 100 U syringes whereas with Vetsulin you use 40 U syringes.


Patty 11-08-2010 06:23 AM

Re: Switching from Vetsulin to NPH
I definitely agree with Jenny and Alison. If you give the regular shot of Caninsulin in the evening, you can start with the NPH in the morning. But I would reduce the dose by 25% (so if you're giving 8u Caninsulin, you'd give 6u NPH to start), and work you're way back up.

The different insulins can create a different curve or peaking action which is the reason for the initial decrease.

I would also ask for the U100 - 31 gauge, 3/10cc short needle syringes with 1/2 unit marks.

We've had many here switch and can help you through the process if you'd like :)


CarolW 11-08-2010 07:29 AM

Re: Switching from Vetsulin to NPH
I'm a very visual person, so to understand the differences with UNITS (which is the proper measurement for any insulin) and MARKS on the syringe barrel - which shows WHY you need to change syringes when you change insulins (unless you want to go through calculations), I made a series of diagrams showing how the VOLUME of fluid for Caninsulin (or Vetsulin - same stuff) is far greater for one UNIT than is the volume of insulin for NPH insulin - that would be, say, Novolin-N or Humulin-N - not the same, but very similar.

With a fair bit of time and some patience, you could browse through my rather silly stories concerning measurements of these two insulins - Vetsulin (or Caninsulin - same stuff), and Novolin-N (or Humulin-N, so similar that usually the differences are negligible).

If you actually browse through those pages in order, you SHOULD end up with a rather intuitive understanding of UNITS and VOLUME, which helps protect against accidents caused by, say, using the wrong syringes. It's possible to UNDER-dose by using U-100 syringes with U-40 insulin. But using U-40 syringes with U-100 insulin (Novolin-N, Humulin-N, or their ReliOn versions from Walmart), can easily just kill a dog - who would then be getting 2.5 times as much insulin as should be injected.

I read about some error somewhere with a recall (I think it was on this forum), where syringes were marked incorrectly; that is, a box of U-100 syringes, if I remember right, contained a number of U-40 syringes. On the surface, if you don't look closely, the two different kinds of syringes look rather similar, though when giving small doses, I'd think the caretaker would notice s/he's drawing up a LOT more insulin if using U-40 syringes when the proper syringes are U-100. But you'd only notice that if you had been using U-100 syringes for some time before; if you're NEW to the change, you might not be aware.

I think we had a situation like that here on the forum, where a vet told the caretaker s/he could use U-40 syringes with NPH (U-100) syringes. It was, I think, sometime in the past year or so that this happened.

Mon, 8 Nov 2010 06:28:50 (PST)

k9diabetes 11-08-2010 10:25 AM

Re: Switching to NPH - question on process
The vet's plan definitely is not per any of the protocols set out by the AAHA or Dr. Nelson at UC Davis Vet School.

The standard protocol is to reduce the dosage when you start the new insulin and give it when the next injection is due.

Recommendations vary on how much to reduce it but we have seen excellent success with 25%. So, as Patty noted, I would cut from 8 units down to 5 or 6 units with the first injection of NPH.

It's not a bad idea to make any such switch when someone will be home with her to observe her reaction just as a precaution. NPH in very rare cases can generate an allergic reaction, for example. So if you have to be at work when the switch is made, I would switch at the dinner time injection and stay home with her that evening.

We have seen literally dozens of dogs switched this way without any problem. Whereas leaving her without insulin for two days would be very very dangerous.

Confusion about how to make the switch is somewhat common, unfortunately.

If you think your vet would be interested, there is a web seminar that was given on how to switch cats and dogs to new insulins - and of course you can listen to it too! :) Dogs are covered during the second half of the webcast:



marydog 11-08-2010 09:59 PM

Re: Switching from Vetsulin to NPH
Thank you all for prompt response to us. I read it today at work but didn't have time to answer. Now I'm feeling comfortable to switch Mary to NPH in the morning instead of 2 days "washout". I couldn't even think about 2 days washout without crying. Caninsulin ends probably on Wednesday or Thursday. Today after work I picked up Novolin GE NPH and syringes from pharmacy. In pharmacy they already prepared syringes. I knew exactly what I need - U100, 31 gauge, 3/10cc short needle syringes with 1/2 unit marks Thanks Patty!!! And, oh surprise, they prepared for me what I needed - BD ultra fine II, 3/10 cc, 8mm length needle (it is shorter then Caninsulin U40 needles), 31 gauge. And of course Id like if you help to go through the process. Im sure would have some questions or worries. I think to start with 5.5 units. We do injections at 6 am and 6 pm. She is on dry Royal Canine Medi Cal Weight Control food. Mary is ausix - mix of Border Collie and Australian Shepherd. In July 2009 when she was diagnosed with diabetes her weight was 30kg and now she is 22.3 kg.


Patty 11-09-2010 06:34 AM

Re: Switching to NPH - question on process
Very glad to hear it Olga! :)

marydog 11-09-2010 09:32 PM

Re: Switching to NPH - question on process
I think that CarolW reply on old thread but anyway thank you CarolW for your info. I bookmarked the links that you provided. If somebody wants to know our experience with Caninsulin I can share it. Important moment (for us) is so close as we are ready to switch Mary to NPH on Thursday morning. I will share our experience. My questions are "When we need to expect a hit from NPH? What time after shot we need to monitor more closely?"

Thanks, Olga.

Patty 11-09-2010 09:43 PM

Re: Switching to NPH - question on process
Each dog responds a bit different. Some have a "mountain" shaped curve where lowest blood sugar is at injection times.

Others may have a "valley" curve where lowest blood sugar is mid-day. This is more common. NPH typically peaks around 5-6 hours post injection, so you might watch this time period closely.

You'll know more about how the food and insulin are working once you've switched and are able to do a curve, but I'd watch the 5-6 hour time period in particular.

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