Open Sat 9:00am: 01582 842096

Caninsulin Insulin for Dogs & Cats

Caninsulin Insulin for Dogs & Cats

Caninsulin is derived from porcine insulin, which is chemically identical to the insulin found in dogs. It has an intermediate period of activity, meaning that it can suit once or twice daily treatment regimes for diabetes mellitus. It is important that your vet performs the appropriate blood tests and tailors a treatment protocol which suits your individual dog or cat.

It is important to note that the concentration of Caninsulin is different from all other types of insulin available on the market. (This was done to make it easier to give the smaller doses often needed compared with human treatments.) This means that only Caninsulin syringes are suitable for use with Caninsulin (calibrated at 40 international units per ml) and human syringes (calibrated at 100 international units per ml) should not be used because they will not give the stated dose. Caninsulin can be given by conventional syringe and needle, or using the Caninsulin Vetpen which takes 2.7ml cartridges and single use, disposable needles. For more information on treatment, see below:

The basic rules for successful treatment of diabetes mellitus in dogs and cats revolve around correct, consistent feeding and a regular, consistent daily routine. Suitable diets are lower in carbohydrate and higher in fat and protein than many commercial diets. An animal on a once-daily injection of insulin should receive about one third of the daily food ration at the same time as the injection, then the main meal of the day should be given to coincide with the peak activity of that injection, which is usually about 8 hours later. Animals on twice daily injections can be fed more evenly through the day which tends to suit cats much better. Dogs and cats show a very poor response to the tablets used for some types of diabetes in people (the oral hypoglycaemics) and so insulin injections every day are the only real option.

If the amount of insulin given is too low, then your dog or cat will have an excessive thirst and may lose weight. There will also be a significant risk of other problems, such blindness. (Due to diabetic cataracts in dogs, or diabetic retinopathy in cats.) If too much insulin is given, your pet will feel unwell and might well suffer a hypoglycaemic episode (a "hypo") which can cause weakness, staggering and trembling, occasionally leading to fitting, coma and even and death. (If this is happening, it can quickly be rectified by giving a little glucose or honey by mouth.) DO NOT give extra insulin! Hence It is important to have regular blood tests to monitor how well treatment is working. With care it is usually possible to treat dogs or cats very successfully for years. It is also interesting to note that a fair proportion of cats will only suffer from diabetes temporarily, and spontaneous recovery does sometimes happen. Recovered cats no longer require insulin injections, as long as they are maintained on a suitable diet. Caninsulin is not licensed for use in cats, but there are currently no licensed treatments for diabetes in cats. Caninsulin is found by vets to work very well in cats.

How to use Caninsulin VetPen:

VetPen Starket Kit includes:

  • Caninsulin Vetpen: Caninsulin delivery device, available in two sizes: 0.5-8IU (0.5 unit dose increments) and 1-16IU (1 unit dose increments)
  • Quick Pen Components Guide: Simple, illustrated diagram that shows Caninsulin VetPen components and accessories
  • Client Instruction Booklet: Easy-to-follow, step-by-step instructions with photos that show clients how to load, use and store the pen
  • Needles: 28 VetPen needles to get you started
  • Needle Remover: Device that allows for safe removal of needles from the pen
  • Handling Adapters: Release button extension and dose selector adaptor to enhance user handling
  • Travel Pouch: Flexible pouch holds pen, needles, sharps remover adaptors and insulin.

Description

Caninsulin 40 iu/ml Suspension for injection

Qualitative and quantitative composition

Each ml contains: Insulin*40 IU.

*(Porcine insulin present as approximately 30% amorphous Zinc insulin and 70 % crystalline Zinc insulin in a suspension). Preservative: methylparahydroxybenzoate 0.1 % w/v.

For full list of excipients, see section Pharmaceutical Particulars.

Pharmaceutical form

White to nearly white suspension for injection.

Clinical particulars

Target species

Dogs and cats.

Indications for use

The product is an intermediate acting insulin product containing porcine insulin, which is structurally identical to canine insulin. It is indicated in cases of diabetes mellitus (insulin deficiency) in dogs and cats, where the required blood levels are achieved by using an individually adjusted dose of the product.

Contra-indications

The product must not be administered by the intravenous route. The product is a medium duration insulin and is not intended for the treatment of animals with severe acute diabetes presenting in a ketoacidotic state.

Special warnings for each target species

In the cat diabetic remission is possible.

Special precautions for use

Before the product is administered owners should be instructed to have a box of powdered glucose at home. Signs of hunger, increasing anxiety, unstable locomotion, muscle twitching, stumbling or sinking in the rear legs and disorientation indicate progression of hypoglycaemia and requires immediate administration of glucose solution and food to restore blood glucose levels.

Polyuria, polydipsia and polyphagia in combination in chronic cases with weight loss, general bad condition, loss of hair or abnormal furry coat and lethargy are the most common clinical symptoms of hyperglycaemia and require administration of insulin to restore blood glucose levels to the normal range.

The use of progestagens (oestrus inhibitors) in patients suffering from diabetes mellitus should be avoided. Stress and irregular extra exercise must be avoided. Care must be taken with the use of corticosteroids. Ovariohysterectomy may have to be considered.

It is important to establish a strict feeding schedule in consultation with the owner which will include a minimum of fluctuations and changes. Administration of the product must be carried out by an adult responsible for the welfare of the animal.

The product must be administered with specific 40 IU sterile single-use syringes (vial) or with VetPen (cartridge).

Operator warnings:

Accidental self-injection can provoke clinical signs of hypoglycaemia and there is a low possibility of an allergic reaction. In case of accidental self-injection seek medical advice immediately and show the package insert to the doctor. In the unlikely event or accidental eye and skin contact, wash the area with clean, running water.

Adverse reactions

Local injection site reactions have been reported rarely in dogs and very rarely in cats. These reactions are usually mild and reversible. In very rare cases, allergic reactions to porcine insulin have been reported.

Use during pregnancy, lactation or lay

The use of the product is not contra-indicated during pregnancy or lactation but requires close veterinary supervision to account for changes in metabolic requirements during this period.

Interactions

Changes in insulin requirements may result from administration of substances which alter glucose tolerance, such as corticosteroids, thiazide diuretics, progestogens, amitraz and alpha-2 agonists, such as medetomidine, dexmedetomidine, xylazine. Monitoring of glucose concentrations should be used to adjust the dose accordingly. Similarly, changes in diet or exercise may alter insulin requirements.

Amounts to be administered and administration route

Caninsulin should be administered once or twice daily, as appropriate, by subcutaneous injection. Alternate the injection site daily. Before first use shake the vial thoroughly until a homogeneous, uniformly milky suspension is obtained. Foam on the surface of the suspension formed during shaking should be allowed to disperse before the product is used and, before each subsequent use, the product should be gently mixed to maintain a homogeneous, uniformly milky suspension before use. Agglomerates can form in insulin suspensions: do not use the product if visible agglomerates persist after shaking thoroughly.

Vial: Before each use invert the vial a few times before use until a homogenous suspension is obtained. A 40 IU/ml insulin syringe should be used.

Cartridge: Before each use invert the vial a few times before use until a homogenous suspension is obtained. The cartridge is designed to be used with VetPen. VetPen is accompanied by a package leaflet with detailed instruction for use to be followed. The injection procedure when using VetPen is as follows:

1.Peel the protective film from a new pen needle. Screw the pen needle straight onto the cartridge holder. Remove the outer protective needle cap from the pen needle. Replace the pen cap onto the insulin pen. Turn the pen up and down at least 10 times.

2.It is important to remove the air from the cartridge (prime the pen) before use to avoid injection of air and ensure proper dosing. Dial 1 unit on the dose selector. Remove the pen cap and the needle cap. Position the pen carefully with the needle pointing vertically upwards. Tap the cartridge gently with your finger a few times to push any air bubbles to the top of the cartridge. Push and hold the release button towards the needle until the arrow (>) on the pen body points to the start line (-) on the dose selector. A small amount of insulin may appear at the needle tip before the pen is fully primed. Repeat steps 1 and 2 until insulin drips actively or squirts out of the needle tip. Confirm that the pen is fully primed by ensuring that the air bubble is no longer visible in the cartridge window during inversion. The insulin pen is now primed and ready for use.

3.Make sure the arrow (>) on the pen body points to the start line (-) on the dose selector. If it does not, please refer to ‘Priming Advice’ on the leaflet supplied with the VetPen.

4.Dial up the number of units required per your veterinary surgeon’s direction. Never attempt to forcefully dial back the dose selector, as doing so may damage the insulin pen and result in inaccurate dosing. If at any time you select too high a dose, we recommend that the incorrect dose is fully expelled into a safe place and the required dose is redialled. Make sure before injecting that the arrow (>) points towards the correct number of units on the dose selector.

5.The injection should be performed subcutaneously, 2 to 5 cm (¾ to 2 in) from the dorsal midline, varying from behind the scapulae (shoulder) to the mid-lumbar region (mid-back) and alternating sides. Insert the needle using the injection technique recommended by your veterinary surgeon then push the release button towards the pen needle and hold it in place until the start line on the dose selector returns to the arrow on the pen body (>-). Releasing the button prematurely will result in incomplete delivery of the dose. After the start line returns to the arrow, wait for a minimum of 5 seconds before removing the needle from the skin.

If the needle is removed or dislodged from the skin too early, you may observe small drops of insulin leaking from the needle, which can result in incomplete dosing. If this occurs, do not attempt to re-dose. Wait and give your pet its usual dose at the next injection.

If the dose selector stops before the start line on the dose selector (-) returns to the arrow on the pen body (>), this indicates that your pet has not received a full dose. If only a partial dose is administered, do not attempt to re-dose. Wait and give your pet its usual dose at the next injection.

When changing between dosing devices (syringes or VetPen), owners should be advised to monitor their animal closely to detect any changes in behavior or clinical condition. A dose adjustment may be required.

A once daily injection is sufficient to reduce the blood glucose concentration in most diabetic dogs. However, the duration of action may vary, making it necessary to administer the insulin dose twice daily to some diabetic dogs.

In diabetic cats, it is necessary to administer Caninsulin twice daily.

The dose depends on the degree of deficit in the animal's own insulin production and is therefore different in each case.

Stabilisation phase

Dog: Insulin therapy is initiated with the starting dose of 0.5 to 1.0 IU/kg body weight once daily, rounded down to the lowest entire number of units.

Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose by approximately 10% according to the evolution of the diabetes clinical signs and to the results of serial blood glucose measurement. Alterations in dose should not normally be made more frequently than every 3 days.

The duration of insulin action as determined by blood glucose curve, may require treatment to be administered twice daily. In such cases, the dose per injection must be decreased by 25% so that the total daily dose is less than doubled. For example for a 10 kg dog receiving 5 IU once daily, the new dose (rounded down to the nearest whole unit) would be 3 IU per injection initially. The new doses should be administered at 12-hour intervals. Further dose adjustments should be made progressively as previously explained. Following switching to twice daily dosing, it is recommended that the clinical signs and blood glucose response be monitored closely.

To achieve a balance between the generation of glucose and the effect of the product, feeding should be synchronized with the treatment and the daily ration divided into two meals. The composition and quantity of the daily food intake should be constant. In dogs treated once daily, the second meal is usually fed at the time of peak insulin effect. In dogs treated twice daily, feeding coincides with Caninsulin administration. Each meal should be fed at the same time each day.

Cat: The initial dose is 1 IU or 2 IU per injection based on the baseline blood glucose concentration, as presented in the following table. Cats require twice daily administration.

Cat blood glucose concentration

Starting dose per cat

<20 mmol/l or < 3.6 g/l (<360 mg/dl)

1 IU twice daily

≥20 mmol/l or ≥ 3.6 g/l (≥360 mg/dl)

2 IU twice daily

The starting dose should not exceed 2 IU per injection.

The composition and quantity of the daily food intake should be constant.

Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose according to the results of serial blood glucose measurement. Alterations in dose should not normally be made more frequently than every week. Increments of 1 IU per injection are recommended. Due to the day-to-day variation in the blood glucose response, and the variations in insulin responsiveness that are seen with time, larger or more frequent increases in dose are not recommended.

Maintenance phase in dogs and cats

Once the maintenance dose has been reached and the animal is stabilized, a long term management program needs to be established. The aim should be to manage the animal in such a way as to minimize the variations in its insulin requirement. This includes clinical monitoring to detect under or over dosage of insulin and adjustment of dose if required. Careful stabilization and monitoring will help to limit the chronic problems associated with diabetes, including cataracts (dogs), fatty liver (dogs and cats), etc.

Follow up examinations should be performed every 2-4 months (or more often if there are problems) to monitor the animal’s health, the owners records and biochemical parameters (like blood glucose and/or fructosamine concentration). Adjustments to the insulin dose should be made based on interpretation of the clinical signs supported by the laboratory results.

Somogyi overswing, also called rebound hyperglycaemia, is a response to an overdose of insulin insufficient to cause, potentially fatal, hypoglycaemia. As hypoglycaemia begins to develop, a hormonal response is triggered which results in the release of glucose from hepatic glycogen stores. This results in rebound hyperglycaemia which may also manifest as glycosuria for part of the 24-hour cycle. There is a danger that the Somogyi overswing is interpreted as a requirement for increase in the insulin dose rather than a decrease. This can be avoided by basing decisions on serial blood glucose measurements rather than single point measurements.

The ability of pet owners to recognize the signs of hypo- or hyperglycaemia and respond appropriately is very important.

Overdose

Before the product is administered owners should be instructed to have a box of powdered glucose at home. Signs of hunger, increasing anxiety, unstable locomotion, muscle twitching, stumbling or sinking in the rear legs and disorientation indicate progression of hypoglycaemia and require immediate administration of glucose solution and food to restore blood glucose levels.

Withdrawal periods

Not applicable.

Pharmacological particulars

ATC Vet Code QA10AC03. Drugs used in Diabetes and Analogues for injection, intermediate-acting, Insulin (pork).

Pharmacotherapeutic group: antidiabetic.

Pharmacodynamic properties

Summary presentation of the active principle

The active ingredient highly purified porcine insulin is a naturally occurring hormone produced by the pancreas by the beta cells in the Islets of Langerhans. The overall effect of insulin is to promote an anabolic state in which there is a net synthesis of carbohydrate, protein and fat.

Insulin facilitates the intake of glucose obtained from food or gluconeogenesis by cells that are in need of energy supply for metabolism. Liver, adipose tissue and brain in particular utilise large amounts of glucose. In diabetes mellitus there is a decreased use of glucose caused by a relative or absolute insulin deficiency. Entrance of glucose into cells is therefore inhibited and glucose accumulates in the body fluids. In diabetic dogs, the action of Caninsulin in blood glucose concentrations, following subcutaneous administration peaks at about 4-8 hours post-injection and lasts for 14-24 hours. In diabetic cats the action of Caninsulin on blood glucose concentrations after subcutaneous administration peaks at about 4-6 hours and last for 8-12 hours post injection.

Pharmacokinetic particulars

The product is an intermediate acting product containing 30% amorphous insulin, which exerts an effect at about 3 hours after subcutaneous injection and has a duration of effect of about 6-8 hours, and 70% crystalline insulin which has a slower onset and a maximum effect between 7-12 hours after injection and a duration of 16-24 hours.

Pharmaceutical particulars

Excipients

Methylparahydroxybenzoate 0.1 % w/v, Zinc chloride, Sodium acetate trihydrate, Sodium chloride, Hydrochloric acid or Sodium hydroxide (for pH adjustment) and Water for injections.

Major incompatibilities

None known.

Shelf life

Shelf life of the veterinary medicinal product as packaged for sale: 2 years.

Shelf life after first opening of the immediate packaging: 28 days.

Special precautions for storage

Store upright and refrigerated between + 2°C and + 8°C. Protect from light. Do not freeze. After first opening store refrigerated at between + 2°C and + 8°C or not above 25°C.

Immediate packaging

Carton with 5 or 10 glass vials (Ph.Eur. Type I) of 2.5 ml with a rubber stopper and aluminium cap, or a carton with 1 glass vial (Ph.Eur. Type I) of 10 ml with a rubber stopper and aluminium cap. 2.7 ml glass Type I cartridge with two sterile colourless Type I glass beads 2.4-2.5 mm in diameter. Closed with a red, 10 mm bromobutyl rubber plunger on the bottom, and with a gold coloured, 7.5 mm bi-layer bromobutyl rubber/polyisoprene stopper and an aluminium crim cap on top. Available in cartons of 10 x 2.7 ml cartridges. The glass cartridge is designed to be used with the injector VetPen 8 or VetPen 16. Not all pack sizes may be marketed.

Disposal

Any unused product or waste materials should be disposed of in accordance with national requirements.

Marketing Authorisation Holder (if different from distributor)

Marketing authorisation number

Vm 01708/4244.

Date of the first authorisation or date of renewal

8 December 1992.

Date of revision of the text

March 2014.

Any other information

For animal treatment only. Keep out of the sight and reach of children.

Legal category

POM-V

GTIN (Global Trade Item No)

Caninsulin 10x2,5ml:

08713184006912,

Caninsulin 1x10m:

08713184013514,

Caninsulin cartridges 10x2,7ml:

08713184113856

Caninsulin 40 iu/ml Suspension for injection

Qualitative and quantitative composition

Each ml contains: Insulin*40 IU.

*(Porcine insulin present as approximately 30% amorphous Zinc insulin and 70 % crystalline Zinc insulin in a suspension). Preservative: methylparahydroxybenzoate 0.1 % w/v.

For full list of excipients, see section Pharmaceutical Particulars.

Pharmaceutical form

White to nearly white suspension for injection.

Clinical particulars

Target species

Dogs and cats.

Indications for use

The product is an intermediate acting insulin product containing porcine insulin, which is structurally identical to canine insulin. It is indicated in cases of diabetes mellitus (insulin deficiency) in dogs and cats, where the required blood levels are achieved by using an individually adjusted dose of the product.

Contra-indications

The product must not be administered by the intravenous route. The product is a medium duration insulin and is not intended for the treatment of animals with severe acute diabetes presenting in a ketoacidotic state.

Special warnings for each target species

In the cat diabetic remission is possible.

Special precautions for use

Before the product is administered owners should be instructed to have a box of powdered glucose at home. Signs of hunger, increasing anxiety, unstable locomotion, muscle twitching, stumbling or sinking in the rear legs and disorientation indicate progression of hypoglycaemia and requires immediate administration of glucose solution and food to restore blood glucose levels.

Polyuria, polydipsia and polyphagia in combination in chronic cases with weight loss, general bad condition, loss of hair or abnormal furry coat and lethargy are the most common clinical symptoms of hyperglycaemia and require administration of insulin to restore blood glucose levels to the normal range.

The use of progestagens (oestrus inhibitors) in patients suffering from diabetes mellitus should be avoided. Stress and irregular extra exercise must be avoided. Care must be taken with the use of corticosteroids. Ovariohysterectomy may have to be considered.

It is important to establish a strict feeding schedule in consultation with the owner which will include a minimum of fluctuations and changes. Administration of the product must be carried out by an adult responsible for the welfare of the animal.

The product must be administered with specific 40IU sterile single-use syringes (vial) or with VetPen (cartridge).

Operator warnings:

Accidental self-injection can provoke clinical signs of hypoglycaemia and there is a low possibility of an allergic reaction. In case of accidental self-injection seek medical advice immediately and show the package insert to the doctor. In the unlikely event or accidental eye and skin contact, wash the area with clean, running water.

Adverse reactions

Local injection site reactions have been reported rarely in dogs and very rarely in cats. These reactions are usually mild and reversible. In very rare cases, allergic reactions to porcine insulin have been reported.

Use during pregnancy, lactation or lay

The use of the product is not contra-indicated during pregnancy or lactation but requires close veterinary supervision to account for changes in metabolic requirements during this period.

Interactions

Changes in insulin requirements may result from administration of substances which alter glucose tolerance, such as corticosteroids, thiazide diuretics, progestogens, amitraz and alpha-2 agonists, such as medetomidine, dexmedetomidine, xylazine. Monitoring of glucose concentrations should be used to adjust the dose accordingly. Similarly, changes in diet or exercise may alter insulin requirements.

Amounts to be administered and administration route

Caninsulin should be administered once or twice daily, as appropriate, by subcutaneous injection. Alternate the injection site daily. Shake the vial thoroughly until a homogeneous, uniformly milky suspension is obtained. Foam on the surface of the suspension formed during shaking should be allowed to disperse before the product is used and, if required, the product should be gently mixed to maintain a homogeneous, uniformly milky suspension before use. Agglomerates can form in insulin suspensions: do not use the product if visible agglomerates persist after shaking thoroughly.

Vial: Invert the vial a few times before use until a homogenous suspension is obtained. A 40 IU/ml insulin syringe should be used.

Cartridge: The cartridge is designed to be used with VetPen. VetPen is accompanied by a package leaflet with detailed instruction for use to be followed. The injection procedure when using VetPen is as follows:

•Peel the protective film from a new pen needle. Screw the pen needle straight onto the cartridge holder. Remove the outer protective needle cap from the pen needle. Replace the pen cap onto the insulin pen. Turn the pen up and down at least 10 times.

•It is important to prime the pen before use to avoid injection of air and ensure proper dosing. Dial one unit on the dose selector. Remove the pen cap. Hold the pen with the needle pointing up. Tap the cartridge gently with your finger a few times to push any air bubbles to the top of the cartridge. Push and hold the release button towards the needle until the arrow (>) on the pen body points to the starting line (-) on the dose selector. Repeat until a drop of insulin appears at the needle tip. The insulin pen is now ready for use.

•Make sure the arrow (>) on the pen body points to the start line (-) on the dose selector.

•Dial up the number of units required per your veterinarian’s direction.

•The injection should be performed subcutaneously, 2 to 5 cm (3/4 to 2 in) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides. Insert the needle using the injection technique recommended by your veterinarian then push the release button towards the pen needle and hold it in place until the start line on the dose selector returns to the arrow on the pen body (>-). Count to a minimum of 5 seconds before removing the needle from the skin.

If the dose selector stops before the start line (-) returns to the arrow (>), this indicates that your pet has not received a full dose.

If only a partial dose is administered, do not attempt to re-dose. Wait and give your pet its usual dose at the next injection. If your pet dislodges the needle before the count of 5, do not attempt to re-dose. Wait and give your pet its usual dose at the next injection. When changing between dosing devices (syringes or VetPen), owners should be advised to monitor their animal closely to detect any changes in behaviour or clinical condition. A dose adjustment may be required. A once daily injection is sufficient to reduce the blood glucose concentration in most diabetic dogs. However, the duration of action may vary, making it necessary to administer the insulin dose twice daily to some diabetic dogs. In diabetic cats, it is necessary to administer Caninsulin twice daily. The dose depends on the degree of deficit in the animal's own insulin production and is therefore different in each case.

Stabilisation phase

Dog: Insulin therapy is initiated with the starting dose of 0.5 to 1.0 IU/kg body weight once daily, rounded down to the lowest entire number of units. Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose by approximately 10% according to the evolution of the diabetes clinical signs and to the results of serial blood glucose measurement. Alterations in dose should not normally be made more frequently than every 3 days.

The duration of insulin action as determined by blood glucose curve, may require treatment to be administered twice daily. In such cases, the dose per injection must be decreased by 25% so that the total daily dose is less than doubled. For example for a 10 kg dog receiving 5 IU once daily, the new dose (rounded down to the nearest whole unit) would be 3 IU per injection initially. The new doses should be administered at 12-hour intervals. Further dose adjustments should be made progressively as previously explained. Following switching to twice daily dosing, it is recommended that the clinical signs and blood glucose response be monitored closely. To achieve a balance between the generation of glucose and the effect of the product, feeding should be synchronized with the treatment and the daily ration divided into two meals. The composition and quantity of the daily food intake should be constant. In dogs treated once daily, the second meal is usually fed at the time of peak insulin effect. In dogs treated twice daily, feeding coincides with Caninsulin administration. Each meal should be fed at the same time each day.

Cat:The initial dose is 1 IU or 2 IU per injection based on the baseline blood glucose concentration, as presented in the following table. Cats require twice daily administration.

Cat blood glucose concentration

Starting dose per cat

<20 mmol/l or < 3.6 g/l (<360 mg/dl)

1 IU twice daily

≥20 mmol/l or ≥ 3.6 g/l (≥360 mg/dl)

2 IU twice daily

The starting dose should not exceed 2 IU per injection. The composition and quantity of the daily food intake should be constant. Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose according to the results of serial blood glucose measurement. Alterations in dose should not normally be made more frequently than every week. Increments of 1 IU per injection are recommended. Due to the day-to-day variation in the blood glucose response, and the variations in insulin responsiveness that are seen with time, larger or more frequent increases in dose are not recommended.

Maintenance phase in dogs and cats

Once the maintenance dose has been reached and the animal is stabilised, a long term management program needs to be established. The aim should be to manage the animal in such a way as to minimize the variations in its insulin requirement. This includes clinical monitoring to detect under or over dosage of insulin and adjustment of dose if required. Careful stabilization and monitoring will help to limit the chronic problems associated with diabetes, including cataracts (dogs), fatty liver (dogs and cats), etc. Follow up examinations should be performed every 2-4 months (or more often if there are problems) to monitor the animal’s health, the owners records and biochemical parameters (like blood glucose and/or fructosamine concentration). Adjustments to the insulin dose should be made based on interpretation of the clinical signs supported by the laboratory results. Somogyi overswing, also called rebound hyperglycaemia, is a response to an overdose of insulin insufficient to cause, potentially fatal, hypoglycaemia. As hypoglycaemia begins to develop, a hormonal response is triggered which results in the release of glucose from hepatic glycogen stores. This results in rebound hyperglycaemia which may also manifest as glycosuria for part of the 24-hour cycle. There is a danger that the Somogyi overswing is interpreted as a requirement for increase in the insulin dose rather than a decrease.This can be avoided by basing decisions on serial blood glucose measurements rather than single point measurements. The ability of pet owners to recognize the signs of hypo- or hyperglycaemia and respond appropriately is very important.

Overdose

Before the product is administered owners should be instructed to have a box of powdered glucose at home. Signs of hunger, increasing anxiety, unstable locomotion, muscle twitching, stumbling or sinking in the rear legs and disorientation indicate progression of hypoglycaemia and require immediate administration of glucose solution and food to restore blood glucose levels.

Withdrawal periods

Not applicable.

Pharmacological particulars

ATC Vet Code QA10AC03. Pharmacotherapeutic group Drugs used in Diabetes and Analogues for injection, intermediate-acting, Insulin (pork).

The active ingredient highly purified porcine insulin is a naturally occurring hormone produced by the pancreas by the beta cells in the Islets of Langerhans. The overall effect of insulin is to promote an anabolic state in which there is a net synthesis of carbohydrate, protein and fat. Insulin facilitates the intake of glucose obtained from food or gluconeogenesis by cells that are in need of energy supply for metabolism. Liver, adipose tissue and brain in particular utilise large amounts of glucose. In diabetes mellitus there is a decreased use of glucose caused by a relative or absolute insulin deficiency. Entrance of glucose into cells is therefore inhibited and glucose accumulates in the body fluids. In diabetic dogs, the action of Caninsulin in blood glucose concentrations, following subcutaneous administration peaks at about 4-8 hours post-injection and lasts for 14-24 hours. In diabetic cats the action of Caninsulin on blood glucose concentrations after subcutaneous administration peaks at about 4-6 hours and last for 8-12 hours post injection. The product is an intermediate acting product containing 30% amorphous insulin, which exerts an effect at about 3 hours after subcutaneous injection and has a duration of effect of about 6-8 hours, and 70% crystalline insulin which has a slower onset and a maximum effect between 7-12 hours after injection and a duration of 16-24 hours.

Pharmaceutical particulars

Excipients

Methylparahydroxybenzoate 0.1 % w/v, Zinc chloride, Sodium acetate trihydrate, Sodium chloride, Hydrochloric acid or Sodium hydroxide (for pH adjustment) and Water for injections.

Major incompatibilities

None known.

Shelf life

Shelf life of the veterinary medicinal product as packaged for sale: 2 years.

Shelf life after first opening of the immediate packaging: 28 days.

Special precautions for storage

Store upright and refrigerated between + 2°C and + 8°C. Protect from light. Do not freeze. After first opening store refrigerated at between + 2°C and + 8°C or not above 25°C.

Immediate packaging

Carton with 5 or 10 glass vials (Ph.Eur. Type I) of 2.5 ml with a rubber stopper and aluminium cap, or a carton with 1 glass vial (Ph.Eur. Type I) of 10 ml with a rubber stopper and aluminium cap. 2.7 ml glass Type I cartridge with two sterile colourless Type I glass beads 2.4-2.5 mm in diameter. Closed with a red, 10 mm bromobutyl rubber plunger on the bottom, and with a gold coloured, 7.5 mm bi-layer bromobutyl rubber/polyisoprene stopper and an aluminium crim cap on top. Available in cartons of 10 x 2.7 ml cartridges. The glass cartridge is designed to be used with the injector VetPen 8 or VetPen 16. Not all pack sizes may be marketed.

Disposal

Any unused product or waste materials should be disposed of in accordance with national requirements.

Marketing Authorisation Holder (if different from distributor)

Date of the first authorisation or date of renewal

8 December 1992.

Date of revision of the text

June 2011.

Any other information

Nil

Legal category

POM-V

Need help or advice? Contact us:

  • Freephone: 0800 084 2608
  • Mon - Fri: 8:30am - 7:00pm
  • Sat: 9:00am - 3:00pm
  • Email: support@viovet.co.uk

All prices include VAT where applicable.

Reviews of Caninsulin Insulin for Dogs & Cats

Read our customers' reviews of Caninsulin Insulin for Dogs & Cats

Questions & Answers for Caninsulin Insulin for Dogs & Cats

Below are some recent questions we've received regarding Caninsulin Insulin for Dogs & Cats, including answers from our team.

Ask Your Own Question

Should Caninsulin be gently shaken before use?

7th May 2014
Paul

I was given to understand by our vet that Caninsulin should be gently shaken before every administration.

Is this correct or am I mistaken?

Paul

John Cousins
  • Veterinary Surgeon at VioVet

Caninsulin contains a suspension and so can settle out if left still for a long time. On that basis it should be agitated in some way to produce an even dispersion of the contents before withdrawing a dose. The problem with this is that it is well known that repeated, vigorous shaking can denature any type of insulin and render it inactive. The facts are that it only takes a bit of movement to re-suspend the contents and it takes a huge amount of shaking to cause any significant trouble to the insulin. Therefore as long as you are sensible about it, the whole process works very well. It is advised to gently roll the bottle in your hands or on a surface before withdrawing a dose. This can be done twice a day for a month and will be effective, but not damage the insulin. There is a lot more leeway than some people seem to think. (It is recommended that if there is any insulin left after a month, this is discarded and a new bottle started. This is due more to possible contamination than anything else.)

Can you help me work out home much we need

4th Apr 2014
Rachael

Hi, my dog needs 3 units am and pm. If we buy a 10 ml bottle can you tell me how long this will last.

thanks

John Cousins
  • Veterinary Surgeon at VioVet

Caninsulin contains 40 units per ml, therefore in a 10ml bottle you get 10 x 40 = 400 units. If you use 6 units per day, this should last 66 days. However it is not recommended to keep using the bottle for more than 28 days after you have removed the first dose. (Though it lasts for 2 years in the fridge if it is not opened.) Whenever a multi-use injection bottle has first been used, there is an official recommendation to discard any unused product after 28 days, due to degradation which might possibly occur through contaminants accidentally being introduced by the needle when some is withdrawn. I am sure that many people continue to use it longer than 28 days but we cannot recommend this. If you buy a 2.5ml bottle, that should last for 16 days. (2.5 x 40 = 100, 100 / 6 = 16.7)

Caninsulin longevity

10th Mar 2014
marie cane

how long does caninsulin keep its efectiveness after the vial has been opened.

John Cousins
  • Veterinary Surgeon at VioVet

The stability tests on Caninsulin have demonstrated that even if kept at room temperature (below 25 C) and not stored in a fridge, it will remain affective for at least 28 days from opening. How much longer than that it will last for has not been published. This is partly because all multi-dose injections are recommended to be used only for a maximum of 28 days anyway. The chances of contamination through repeated needle entry into the bottle are a concern the longer it is used for. Therefore the arbitrary 28 day maximum has been set as a safe guideline. I expect that it would last much longer than this, especially if kept in the fridge, but the advice is to discard any left after 28 days anyway for safety reasons.

Posting insulin

16th Dec 2013
Stephanie Reid

Is it safe for insulin to be dispatched by post?

John Cousins
  • Veterinary Surgeon at VioVet


As a precaution, we post out insulin in a cold pack, which should keep the product cool for a period of 3 days. However, the fact is that Caninsulin (along with other forms of insulin) is not as temperature sensitive as many people believe. If you read the data sheet from the manufacturer which accompanies the product, you will see that they are confident that it can be stored at room temperature for 28 days. Long-term storage is advised to be at fridge temperature, but they are happy once the product is in use, for it not to be fridged at all. (This has some benefits for patient comfort - the insulin is not cold when injected. Some human hospitals apparently do not fridge their supplies once they are in use. It is important to discard any remaining product once the vial has been broached for 28 days. This is mostly due to potential contamination concerns in fact.)

Other theoretical concerns for insulin being sent by post are prolonged contact with the rubber stopper in the top of the vial, and repeated shaking. Both of these things can cause some degradation of the insulin and reduction of efficacy. However these concerns have been evaluated by various manufacturers and large scale users of insulin, and the degree of degradation in normal circumstances is insignificant. We are confident that Caninsulin can safely be sent by post.

Caninsulin Vetpen for insulin injections

16th Dec 2013
Barbara Sheffield

Do you know if there is such a thing on the market as a Canine version, of the Human Insulin, Epipen?
My mums dog is now having to have 2 injections a day and I wondered if there was an easier way of measuring the dose of insulin, as in the human diabetic's insulin pen?

John Cousins
  • Veterinary Surgeon at VioVet

Yes there is the Caninsulin Vetpen available and this is on our website now. I have not used them personally, but I understand that they are simple enough. The insulin is supplied in Caninsulin Cartridges which makes it a bit more expensive, and the pen itself costs money, but they are designed for easy use and are becoming more popular.

Shaking insulin

11th Dec 2013
Hazel

As you know you are not supposed to shake insulin as it destroys its active ingredients/potency.
Surely sending it in the post will definitely shake it, how is this problem overcome?.
Thanks

John Cousins
  • Veterinary Surgeon at VioVet

There are in fact several reasons why theoretically sending insulin by post is not ideal. In practice, none of them seem to be significant and thousands of bottles are posted regularly and found to be perfectly effective. The insulin molecule can indeed be denatured by repeated shaking, which would render the product inactive. This is important to point out because some people might be tempted to shake the bottle vigorously every time they use it, which can be twice a day for a month. (In the days before the 28 day maximum use limit was introduced, some bottles were in use for several months.) In practice the amount of inadvertent shaking the insulin receives is not found to have a noticeable affect on the quality of the product. Each insulin bottle is moved around several times between manufacture and end use. It will at least be moved by van from manufacturer to wholesaler, then from wholesaler to retailer. At all times care is taken to do this with the nature of the product in mind. Fortunately insulin molecule is not as fragile as some people fear, and the system works very well.

Insulin also denatures when stored in contact with rubber, or if stored above fridge temperature. When sent by post, it will inevitably be in contact for at least some of the time with the rubber stopper used in the bottle. (When stored in the fridge, it should always be held upright.) Insulin is always posted in an insulated cold pack. However it is difficult to know how effective these packs are, especially when the ambient temperature is very high. Again the concerns seem to be more theoretical than practical. Caninsulin has a 2 year use-by date on it from manufacture. Over this length of time, storage at warm temperatures, or in contact with the rubber stopper, might well cause significant deterioration. Over the short period it is in the post, these concerns have been found not to cause any trouble. (In fact regarding the temperature issue, the data sheet with the product points out that it can be stored for a month at room temperature, so that once the bottle has been brought into use, it does not have to be fridged at all. This can be helpful for pets which are sensitive to cold injections, so it is injected at room temperature. Any product left after 28 days should be discarded, due to possible contamination and degradation, so the temperature issue does not come into pay.)

The main thing to remember is that insulin is not as robust as many other medications and should be treated with care. However it is not terribly fragile either and with a little care, the theoretical concerns do not amount to anything in practice. Experience has shown that in using insulin sent by post works perfectly well. The day to day management of a diabetic patient is probably affect more by changes in eating, exercise, "stress" etc, rather than posted insulin.

Related products: