Veterinary Medicine - May 2008 - (Page c11) Use of porcine zinc insulin suspension in the management of canine diabetes mellitus As noted above, any error in product and syringe matching could result in unsuccessful regulation, hypoglycemia, and even death. Therefore, it is strongly advised to educate clients to purchase both Vetsulin and the U-40 syringes from your veterinary clinic. pretransition diabetic regulation is inadequate and observe persistent hyperglycemia (in the absence of insulin-induced hypoglycemia), start the Vetsulin at 75% to 100% of the dosage used with the previous insulin. This is always more of an art than a science, so close patient monitoring is essential whenever changing the type or dose of insulin used. I normally recommend rechecks in seven days (or sooner, if needed) to assess clinical signs and monitor blood glucose concentrations. Alternatively, pet owners can perform blood glucose curves at home (see Strategies for monitoring diabetes mellitus in dogs, page 14). Frequency of dosing. You should initiate twice-daily therapy if you determine the duration of insulin action to be inadequate. If you initiate twice-daily treatment, the two doses should be 25% less than the once-daily dose required to attain an acceptable nadir. Further dose adjustments may be necessary with changes in the dog’s diet, body weight, or concomitant medication or if the dog develops a concurrent infection, in ammation, neoplasia, or an additional endocrine or other medical disorder. Once you establish the maintenance dose and the diabetes appears well regulated, you must implement a long-term management program to minimize variations in the insulin requirement. This includes monitoring to detect insulin underdosage or overdosage and adjustment of dose, if required. Careful monitoring during maintenance will help limit the chronic problems associated with diabetes, including cataracts. In a study conducted in the United States, researchers treated 53 dogs with Vetsulin for 60 days after an initial dose determination period.2 They determined the means of the blood glucose concentrations during 12-hour glucose Dosing Gently roll the vial to mix Vetsulin before withdrawing the dose from the vial. Using a U-40 insulin syringe, administer the injection subcutaneously at 2 to 5 cm (3/4 to 2 inches) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides. According to the manufacturer, the initial recommended Vetsulin dose is 0.5 U/kg body weight once daily given concurrently with or right after a meal. I start the majority of my canine patients on Vetsulin at the same dosage— but given twice a day—and witness few episodes of hypoglycemia. Once you start initial therapy, reevaluate the dog at appropriate intervals and adjust the dose based on clinical signs, urinalysis results, fructosamine concentrations, and glucose curve results until adequate glycemic control is attained. Glycemic control is considered adequate if the patient achieves an acceptable blood glucose curve (i.e., reduction in hyperglycemia and a nadir of 90 to 125 mg/dl), shows improved clinical signs of hyperglycemia (e.g., polyuria, polydipsia, and ketonuria), and avoids hypoglycemia (i.e., blood glucose <80 mg/dl). If you transition a dog from other insulin preparations to Vetsulin and deem the patient’s pretransition diabetic regulation is adequate, start Vetsulin at 50% to 75% of the dosage used with the previous insulin. If you deem the patient’s “To avoid dosing errors when administering Vetsulin to dogs, it is important to use a U-40 syringe. “ 11
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