Insulin Choices

Re: Insulin Choices

Martin Atkinson — Mon, 05 Nov 2012 11:01:26 GMT

[quote user="Mark Holmes"] Curves are largely considered unhelpful or at least that was the opinion at the last diabetes CPD I attended. 50% of decisions made on a curve would be different once the stress of the curve proceedure is eliminated. Particularly in cats but also dogs to a lesser degree. You also have differing activity levels and appetite when they are at the clinic. If you have owners that can home monitor it is better.[/quote] Agreed to an extent, I've been lucky with most of our recent diabetic patients that they have been pretty happy with coming to the surgery, the nurses treat them like stars and they are allowed to wander about when circumstances allow. Home curve take some of the control out of the results - we know we can't trust clients, which also raises the problem with relying on them to have given the correct dose at the correct time correctly. Some of the anomalies I see on curves are I'm sure in part to the client not reliably dosing the patient.

Re: Insulin Choices

Mark Holmes — Sat, 03 Nov 2012 13:21:53 GMT

[quote user="Martin Atkinson"]

[quote user="Thomas Johnson"]

When Insuvet disappeared I moved a cat that had been very stable on Insuvet PZI onto Hypurin PZI at the same dose and it's still doing well, and I have used it in another cat that didn't respond well to Caninsulin.

[/quote] Its strange. I always had my DM cats on PZI once a day and they were all quite stable (including my own) until I went to a seminar that suggested that twice daily lente was more appropriate. After that my PZI cats became unstable (including my own!) and I have long since gone to Caninsulin bid. May also coincided with me being much more diligent about monitoring with glucose curves as well though!

[/quote] Curves are largely considered unhelpful or at least that was the opinion at the last diabetes CPD I attended. 50% of decisions made on a curve would be different once the stress of the curve proceedure is eliminated. Particularly in cats but also dogs to a lesser degree. You also have differing activity levels and appetite when they are at the clinic. If you have owners that can home monitor it is better. The last couple of diabetes patients very quickly trying to bite when the monitor came out.

Re: Insulin Choices

Steve Leonard — Sat, 03 Nov 2012 12:38:25 GMT

Hi Chris,

Thanks for that. Which of these would you initially choose for a dog that has a 3-6 hour curve response to caninsulin to try and get a longer duration of effect? Do they have an ultralente?

Cheers

Steve

Re: Insulin Choices

Christopher Saul — Fri, 02 Nov 2012 20:02:37 GMT

Hi Steve,

Hypurin (Wockhardt ltd) is a range of human lisenced insulin products which is available in both porcine and bovine forms; solube, lente, pzi, glargine etc

I think when it comes to long term management, the cascade is not a problem provided you have first tried and failed to stabilise a patient on caninsulin

Also for emergency use, the cascade really isn't a problem..... caninsulin don't have a soluble insulin...

Chris :)

Re: Insulin Choices

Martin Atkinson — Fri, 02 Nov 2012 13:13:08 GMT

[quote user="patrick murphy"]

no, I was interested in the sdvantages of the pens.

I actually do have an idea of glucose curves, I have only been treating diabetics for 30 years.

[/quote] Well I did wonder - you should be more specific or quote the relevant post. The advantages of pens are obvious in that they will eliminate a lot of human error but given many of my cats are on increments of 1/2 units they couldn't cope with this and a lot of my clients are such tight wads they wouldn't want to spend the extra on the pens and cartridges. Anyway, until Caninsulin brought out their pen only 100iu/ml pens were available which wasn't a lot of good if you were using 40iu/ml insulin.

Re: Insulin Choices

patrick murphy — Fri, 02 Nov 2012 12:56:18 GMT

no, I was interested in the sdvantages of the pens.

I actually do have an idea of glucose curves, I have only been treating diabetics for 30 years.

Re: Insulin Choices

Martin Atkinson — Thu, 01 Nov 2012 13:59:01 GMT

[quote user="patrick murphy"]

being thick, I cannot quite get what they are about? and their advantages. please help.

[/quote] I presume you're talking about glucose curves - where have you been in the world of endocrinology, hiding under a hedge?

You serially take blood glucose measurements from the time of the insulin dose until the next one, every hour or two depending on your methodology, you thereby plot a curve with peak and nadir levels which gives you the information to determine the correct insulin dose and to detect abnormalities like a Somogyi effect. It is not really possible to be certain about the stability of your patient without.

Re: Insulin Choices

patrick murphy — Thu, 01 Nov 2012 12:45:20 GMT

being thick, I cannot quite get what they are about? and their advantages. please help.

Re: Insulin Choices

Martin Atkinson — Wed, 31 Oct 2012 17:25:09 GMT

[quote user="Thomas Johnson"]

Re: Insulin Choices

emma o'connor — Wed, 31 Oct 2012 16:53:06 GMT

[quote user="Martin Atkinson"] anyone used the new Caninsulin pens yet? [/quote]

I have started a few diabetic cats on the pens, they seem to work well and the owners much prefer them. We use caninsulin for the majority of our cases and have no problems with duration of action when used twice daily in both dogs and cats.

Re: Insulin Choices

Thomas Johnson — Wed, 31 Oct 2012 16:48:36 GMT

Re: Insulin Choices

Martin Atkinson — Wed, 31 Oct 2012 15:47:51 GMT

I'm doing OK with Caninsulin mostly but I'm tending towards using Lantus (glargine) for cats at the first sign of instability as you get a much flatter curve with less peaks and troughs. Problem is it is 100iu/ml and most cats needing only 2 units and sometimes half units there is a potential margin for error and the pens you can get only measure in whole units. Talking of pens, anyone used the new Caninsulin pens yet?