Which Insulin

Re: Which Insulin

Christopher Saul — Sat, 30 Jul 2011 13:22:05 GMT

Yes, fair point Mark - and indeed I agree with you in principle.

However with regards to the circumstance of once daily dosing of insulin, I would suggest that even PZI is by no means guarenteed to work as a 'once daily' insulin. There are other arguements in favour of trying caninsulin first, other than the cascade.....

For dogs: caininsulin is porcine insulin and antigenically closer to canine insulin than are bovine options ( though I suppose it would be possible to source porcine long acting insulins marketed for humans)

For cats: caninsulin's 40 IU/ml concentration and 2.5ml bottle size option makes giving small doses more practical

Chris

Re: Which Insulin

Mark Holmes — Fri, 29 Jul 2011 12:56:43 GMT

[quote user="Christopher Saul"]

In cases where, for logistical reasons, once daily dosing is the only option( e.g. owner compliance issues) I would start with caninsulin and only use longer acting insulins once I have tried and failed with caninsulin - again I would say the cascade leaves us little choice in the matter.

[/quote]

I would argue against interpreting the casade this way. Just becasue a company has sort to license a particular drug it does not follow that this drug is the most appropriate to use, in fact it may be against the animals interest if it is known that another drug (off licence) is more appropriate for that condition and those circumstances. In that sense its not in line with out oath as veterinary surgeons.

I would argue that the casade should influence our choice of product but not our choice of drug. That should be a clinical decision only. Otherwise our treatment is based largely on the various company's marketing budgets and how they are allocated (actually I would argue against the cascade being anything more than a loose guideline but if we have to live with it then that should be the extent of its power)

Re: Which Insulin

Christopher Saul — Fri, 29 Jul 2011 12:35:18 GMT

[quote user="Anthony Todd"]

Is Hypurin PZI the only daily dose insulin?

[/quote]

I don't think it's particularly useful to pigeon-hole a drug as a 'once daily' or 'twice daily' drug, as all patients should be treated as individuals and the dosing interval determined on a case by case basis. The duration of action even of PZI is often insufficient for once daily dosing in cats; some patients will need twice daily PZI.

I generally will start all of my newly diagnosed diabetic patients on canisulin (nearly always twice daily in the first instance) - I think it's difficult to justify anything else under the cascade, and adjust dosing/insulin type from there.

To adress Anthony's original question of if there are alternate long acting insulins which could perhaps be used in the once daily setting......... ultralente and glargine are in theory longer acting preparations than PZI. As I say however, I would always attempt stabilisation with caninsulin (itself a lente prepartion) before using another preparation off-label.

Hope this helps

Chris

Re: Which Insulin

Martin Atkinson — Fri, 29 Jul 2011 11:27:16 GMT

[quote user="emma o'connor"]

We only stock Caninsulin now for our routine cases, we will order in Lente or PZI for individuals already on this form of insulin and stable. We keep one vial of soluble in stock for any ketoacidotic cases. We find Caninsulin works well for us, and the smaller 2.5ml bottles mean less wastage when on small doses.

[/quote]

?? Caninsulin is a lente insulin! I agree on the value of 2.5ml bottles but its the 40iu/ml which is the real seller especially in cats.

Clive Ansell said: "Caninsulin is licenced for once daily dosing in dogs, and twice daily in cats".

I just looked this up as it intrigued me and I always start dogs on twice daily dosing. The data sheets suggest starting once daily with dogs and change to twice if necessary, it is not a licencing issue.

Re: Which Insulin

Clive Ansell — Fri, 29 Jul 2011 07:53:01 GMT

[quote user="Anthony Todd"]

Is Hypurin PZI the only daily dose insulin?

[/quote]

Caninsulin is licenced for once daily dosing in dogs, and twice daily in cats.

That said I find dogs stabilise better, and I almost always start them off on bid dosing.

Re: Which Insulin

Anthony Todd — Thu, 28 Jul 2011 23:00:20 GMT

Is Hypurin PZI the only daily dose insulin?

Re: Which Insulin

emma o'connor — Thu, 28 Jul 2011 21:50:50 GMT

Re: Which Insulin

Andrew Kent — Thu, 28 Jul 2011 21:07:26 GMT

We stock caninsulin, hypurin Lente, neutral and PZI. Most things over to caninsulin but if have tried that in past unsuccessfully then kept on PZI or Lente as appropriate. Andy

Re: Which Insulin

Anthony Todd — Thu, 28 Jul 2011 19:44:41 GMT

On of my colleagues has said this:

As Insuvet lente & PZI now out of stock most cases have been switched over to Caninsulin.

Only exceptions are cats that were on Insuvet PZI once daily dosing: if they are moved over to Caninsulin they need BID dose - some Owners dont want this - so have been prescribed Hypurin PZI.

Comments please.

Re: Which Insulin

Michael Woodhouse — Thu, 28 Jul 2011 12:52:20 GMT

TBH with the cascade everything should be on Caninsulin unless there's a good reason not to. We have nothing else. You can stabilise DKA's with it, but not as easy as soluble.

Re: Which Insulin

Martin Atkinson — Thu, 28 Jul 2011 11:54:15 GMT

I use Caninsulin for 99% of cases: small bottles for cats, 10ml for dogs. There's one bottle of soluble insulin for emergency use in DKA cases and some glargine left over from a cat that stabilised and didn't require it anymore - maybe there's a moral in that last statement. I would only have something else in if I wanted a change because I suspected resistance.