Switching from Vetsulin to NPH

[amberiu99]

I was wondering if anyone else would be interested in documenting their switch from Vetsulin to NPH on the forum? I plan on doing that and creating a set of documents to pass along to vets once I am through the switch and back to regulation. I want to pass along information to vets that do not have as much experience with diabetes and making the adjustments necessary during this kind of switch. We have a really unique opportunity right now to document massive switching and the ramifications for veterinarians. It is unusual that so many people would be switching at once.

I think that vets focus on not having patients go too low, but sometimes they do not consider the risks of consistently high Bg such as ketoacidosis and long-term effects on organs and future regulation for dogs.

If you are willing to document your progress, please list food type and amount, exercise, insulin amounts before, during, and after the switch, any curves, spot checks, etc.

I will begin to post my information here as we move forward, but I am also going to keep documentation that I can put together in one place. I hope that I can help others who will be going through this process.

It is important to note that each dog responds differently to different insulins. I do not want anyone to think that I am recommending to be agressive in your change. For me, I know my dog, I know what I have seen with him in the past, and I am positive that starting him from ground 0 to get him re-regulated was not the right thing to do for him. Even though I was positive, I still had conversations with my vets to discuss my course of action. I certainly recommend everyone else doing the same.

Best of luck if you are switching!

[BestBuddy]

Re: Switching from Vetsulin to NPH

Buddy had a very non eventful switch from Caninsulin to NPH. He had been regulated for around four years and all of a sudden (other medical problems) the Caninsulin only lasted around 6 hours so we decided to try NPH.
Buddy's food consisted of around 150g of Science Diet Light canned and about 50g of kibble twice a day with injections. He was on 4.8iu of Caninsulin (12 in a U100 syringe).

Now for the non event.....
One Friday evening Buddy was given his normal food and 4.8iu of Caninsulin.
Saturday morning he was given 4iu of NPH and his normal food and apart for the odd 1/2iu change with other problems (UTI,eye infection,ears etc.) this is how he stayed for the next few years before he passed away.

Buddy's food continued to be the same and he was around 5kg. We noticed the first day that the NPH was lasting the 12 hours and BG numbers stayed between 100-250. Within 2-3 days the BG was about 70-190 and continued mostly the same from then on.

I'm glad I didn't start too low on the NPH but we had the advantage of really knowing Buddy and that 4-5iu worked well regardless of the type. Home testing gave me peace of mind.

So for us it was no big deal and I hope those changing have it the same way.

Jenny

[CraigM]

Re: Switching from Vetsulin to NPH

Jenny (and all others),

I'm a little "slow" in figuring the change-over

Do I understand correctly that you gave 4.8IU of Caninsulin in a U40 syringe, and then 4IU of NPH in a U100 syringe?

I still have 2 vials of Vetsulin, but may shift before I start the last vial. Annie will have her yearly vet visit next month and want to have some facts to discuss with the Doc..

Craig

[BestBuddy]

Re: Switching from Vetsulin to NPH

Hi Craig,

I will try (I am not very good at it) to explain about the insulin.

One unit of Vetsulin/Caninsulin is the same as one unit of NPH or any other insulin. It is the volume of liquid that goes into making that one unit that makes it a U40 or a U100.I believe that U40 means 40iu per ml and U100 is 100iu per ml so you would need more liquid of the u40 (2.5 times to be exact) to match the U100 units.

I always talk about insulin in units regardless of what number I fill the syringe because I always used U100 syringes with Canisulin and it was the marker 12 on the U100 syringe but we were giving 4.8 units of insulin so when I changed to NPH it was marker 4 on the U100 syringe which was a true 4 units.

Jenny

[CraigM]

Re: Switching from Vetsulin to NPH

Thanks Jenny.

[mnfila]

Re: Switching from Vetsulin to NPH

Amberiu99,
I'm brand new to this site thanks to you! You pic of your baby puts me in your category. My girl is around 135lbs so... We are just making the switch to nph from vetsulin and the first night was not so good. G.G. was way high and considering we've just been battling a UTI from high sugar, we don't want to stay this way. Any help/advice you can give me from your experience would be highly invaluable. Thanks!!

[CarolW]

Re: Switching from Vetsulin to NPH

Maybe I can give you some ideas, but we'd need more detail from you before we could get specific. I gather you're testing your dog (G.G.?) - using a glucometer? And she weighs 135 pounds? Curious; is she a Fila Brasiliero (wild guess - grin!)? Or what? How old is she? When was she diagnosed with diabetes? What was her Vetsulin dose, and what NPH dose did you change to?

Have you discussed this in detail with your vet? If so, what does your vet say? If not, I think it would be worth having a discussion. If your VET has been doing BG-testing, rather than you, could you get those test results and post them here? Your vet should provide the results without any problems. And if you have been doing the testing, can we see her most recent curves? and/or spot checks?

You might read through the Sticky thread here on protocol for making the change. It seems to be generally agreed that because the curve shape may (likely, will) change with the change of insulin, the safest thing to do is cut the number of units by 20 to 25%. At first, it was suggested to start from scratch, as though the dog had never had insulin before, but that seems to have changed as time went by, which I think is fortunate.

I'm VERY sympathetic with your desire that G.G. shouldn't run high; on the other hand, that's FAR safer than letting her get too low!

You can expect it will take at least three days for G.G. to adapt to the new insulin, so that you see its true effects. Actually, my vet says, better, a week and better yet, two weeks. But my vets wouldn't raise the dose for at least three days, more likely a week, or perhaps two weeks, depending on BG (blood glucose) test results.

All that said, my Kumbi started out on Novolin-NPH insulin, and we never changed the type nor brand that he's on. So I don't personally have any experience with changing types ot insulin You will though, if you look around the forum, find various posts from people who have made the same kind of change you're beginning.

If you're able to test, yourself, with a glucometer, I'd do that; say, at least three spot-checks daily - perhaps at fasting, a.m. and p.m., and at what might be expected to be approximate peak time for NPH insulin - maybe 6 to 8 hours after the morning injection.

Are you feedng and injecting 12 hours apart? That's a standard kind of protocol for any insulin.

I WOULD like to encourage you, and let you know that if you take things step-by-step, without rushing, you should get good results in relatively little time, always assuming G.G. takes well to the NPH insulin, and doesn't have any bad reactions to it.

So, now waiting till we hear more from you! I'll be here watching, and cheering you on!

Fri, 23 Apr 2010 11:35:06 (PDT)

[Patty]

Re: Switching from Vetsulin to NPH

mnfila,
I started a thread just for G.G. on the forum here http://k9diabetes.com/forum/showthread.php?t=1822 so we can keep track of her info in one place.
Welcome!
Patty

[marydog]

Re: Switching from Vetsulin to NPH

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]

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.

Jenny

[AlisonandMia]

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.

Alison

[Patty]

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

Patty

[CarolW]

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]

Re: Switching from Vetsulin to NPH

Marydog, I copied your question and these threads to a new thread so you can have one of your own.

http://www.k9diabetes.com/forum/showthread.php?t=2265

Hoping to hear more about Mary,

Natalie

[CarolW]

Re: Switching from Vetsulin to NPH

Oh, Olga - and MaryDog, you lovely creature, you!

I TOTALLY agree with NOT letting insulin wash out! YES - with changing to the NPH NOW - no going two days without insulin!

As I check your posts, I see that perhaps you're in Canada, as I am, too. That Medi-Cal food worked really well for Kumbi, and ALSO did for my elder dog, Kwali. (We used the Medi-Cal Fibre Formula, which is quite similar to their Weight Control.) And the syringes are just great - you got exactly what I used. My first box was 30-gauge needles, same brand - BD, but the pharmacist, on my second box, happened to hand me exactly the ones you're using, and I used those ever since. Just love them, and Kumbi did, too.

http://www.coherentdog.org/vek/syringes1.php

There are detailed pictures there; they are partly intended to assist people who want to use them with Caninsulin or Vetsulin, to take advantage of the shorter, thinner, needle - so much more comfortable for the dog - therefore also for the human! You can just ignore the remarks about conversions, because with your new NPH insulin, your syringes are MATCHED to the insulin - no conversions needed. That was the same for Kumbi and me. I made conversion remarks to benefit another list, where lots of people were wanting help with it.

I do have a VERY detailed step-by-step description of giving injections to a diabetic dog, and maybe you're one of the people who, as I do, thrive on absolutely excruciating detail! If so, you could leaf through these pages, starting here:

http://www.coherentdog.org/vek/painlessinj.php

I should add that lots of people just find that kind of detail excruciatingly confusing, so don't worry if that happens to you; just skip on past. You can always go back there later if you want to. Lots of my silly jokes in there, too. I have a habit of laughing at diabetes; partly, my vet taught me to laugh!

I never changed insulins for Kumbi, because he started on that same Novolin GE isophane (NPH) insulin you have for Mary, and he had that all his life. He did so well on it that we only had occasional minor dose changes, usually, seasonal, till toward the end of his life, as cancer invaded his system (but we didn't know it was cancer).

Anyway, Kumbi was very stable on it, and I believe would have been, also, had he been on Humulin-N. I found it a very easy insulin to work with, and was glad I never had to cope with Caninsulin, because of the various possibilities for fluctuation in glucose levels.

I'm glad you're posting, and will look forward to your further reports! Kumbi, from the Bridge, takes the liberty of sending you and Mary greetings, and Kwali joins him, as she refuses to be left out! Now Camellia is joining them too, saying, "I don't have diabetes and hope I never get it, but if I do, I'll be safe!" (And I jump in and say, "Camellia, your breed-ancestors, the delightful Bichons, seem often to get diabetes, but I haven't seen Havanese mentioned on the forums.")

Tue, 9 Nov 2010 07:22:47 (PST)