Caninsulin (Canada)

This page contains information on Caninsulin for veterinary use.
The information provided typically includes the following:
  • Caninsulin Indications
  • Warnings and cautions for Caninsulin
  • Direction and dosage information for Caninsulin

Caninsulin

This treatment applies to the following species:
Manufacturer: Merck Animal Health

PORCINE INSULIN ZINC INJECTION (Mfr. Std.)

STERILE SUSPENSION

40 I.U./ML

FOR VETERINARY USE ONLY

DIN 02052474

Description

Caninsulin is an intermediate-acting insulin. Each ml of Caninsulin contains highly purified porcine insulin 40 IU (Ph. Eur.) consisting of 30% amorphous zinc insulin and 70% crystalline zinc insulin (“Lente” type). Non medicinal ingredients include (per ml): zinc chloride 0.08 mg, sodium acetate trihydrate 1.36 mg, sodium chloride 7.0 mg and methyl parahydroxybenzoate 0.1% (as preservative). pH is adjusted by adding hydrochloric acid and/or sodium hydroxide.

Caninsulin Indications

Caninsulin is indicated for the control of hyperglycemia associated with diabetes mellitus in dogs and cats.

Caninsulin Dosage And Administration

The starting dose is calculated based on the dog’s or cat’s body weight as directed in the Tables below. Dose-titration is necessary to meet the treatment needs of each individual animal. After a period of acclimatization, a blood glucose curve should be determined and the dose adjusted to achieve satisfactory long term control (see Monitoring and Dose Adjustment section below).

STARTING DOSE:

Dogs:

The recommended starting dose of Caninsulin is 0.5 I.U. per kg of body weight once daily, rounded down to the lowest entire number of units. Some examples are given in the following table.

Dog Body Weight

Starting Dose Per Dog

5 kg

2 I.U. once daily

10 kg

5 I.U. once daily

15 kg

7 I.U. once daily

20 kg

10 I.U. once daily

STARTING DOSE:

Cats:

The recommended starting dose is 0.25 - 0.5 I.U. per kg of body weight, for a maximum of 2 I.U. per dose, based on blood glucose concentration at diagnosis, 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)

0.25 I.U./kg twice daily

≥ 20 mmol/l or ≥ 3.6 g/l (360 mg/dl)

0.5 I.U./kg twice daily

Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the dose according to clinical signs and serial blood glucose measurements (see Monitoring and Dose Adjustment below).

ADMINISTRATION:

The use of U-40 insulin syringes is strongly recommended to ensure accurate dosing. The insulin vial should be warmed and gently inverted a few times before use until a homogenous suspension is obtained. The suspension should look uniformly milky. Do not use if clumps, particles, or flocculation are present in the vial after mixing. The contents should be used within 6 weeks and stored below 25° C after the first dose is removed. Caninsulin should be injected subcutaneously 2 to 5 cm from the dorsal midline on alternating sides, varying from behind the scapula to the mid-lumbar region. Veterinarians should instruct pet owners on proper storage and handling, show them how to draw the insulin from the bottle, and instruct them on how to administer Caninsulin.

Diet

A nutritionally complete commercial dry or canned pet food should be fed in consistent amounts and at consistent times each day, according to the veterinarian’s recommendations. Animals receiving Caninsulin injections once daily should be fed 1/2 to 2/3 of their caloric requirement at the time of injection and 1/2 to 1/3 of their requirement approximately 8 to 10 hours later, depending on the client’s schedule. Animals receiving Caninsulin injections twice daily should be fed 1/2 of their caloric requirement at the time of each injection.

Monitoring And Dose Adjustment

Since the times to the peaks and the duration of insulin activity from Caninsulin will vary among animals, the dose should be adjusted based on the measurement of blood glucose levels. Blood glucose levels should be determined 2 to 4 hours after each injection for the first 2 days to assure the animal is not becoming dangerously hypoglycemic (blood glucose < 80 mg/dl, 4.4 mmol/L). The animal should then be allowed to acclimate to this treatment 4 to 5 days before determining the glucose curve and adjusting the dose. A glucose curve should be obtained by administering Caninsulin, feeding the animal as described under the DIET section, and measuring blood glucose every 1 to 2 hours for 24 hours. In dogs and cats, the dose should then be adjusted by 10 percent per day until the lowest blood glucose is approaching normal glycemia or between 4.4 - 6.6 mmol/L (80-120 mg/dl). While adjusting the dose, the blood glucose should be measured 2 or 3 times daily, at the times when it is expected to be lowest as determined by the glucose curve, and just before the next dose is to be given.

Once the dose that will reduce blood glucose to 4.4 - 6.6 mmol/L (80-120 mg/dl), is established, the blood glucose curve may need to be repeated to accurately determine the peaks and duration of activity resulting from this dose. In dogs administered Caninsulin once daily, if the duration of insulin action is less than 16 hours (blood glucose is reduced to 4.4 - 6.6 mmol/L (80-120 mg/dl), but increases to 13.9 mmol/L (250 mg/dl) less than 16 hours after administration), Caninsulin may be given twice daily at 12 hour intervals. Initially, the 2 doses should be equal and each dose should be 25% less than the dose that reduced the blood glucose to between 4.4 - 6.6 mmol/L (80-120 mg/dl), when Caninsulin was given once daily. Animals receiving Caninsulin injections twice daily should be fed 1/2 of their caloric requirement at the time of each injection. The doses should then be adjusted as described above. The dose given in the evening may be less than the dose given in the morning, if control of hyperglycemia is improved by doing so.

As an alternative, the insulin dose can be adjusted, based on daily measurement of morning urine glucose levels by the client. Although this is an acceptable method, it is not recommended as the sole criterion upon which to adjust the dose, because factors other than insulin dose can affect urine glucose concentration. In dogs and cats, the aim should be to manage the diabetic animals so as to reduce or eliminate the clinical signs of diabetes mellitus whilst minimizing the occurrence of hypoglycemia; obtain normal blood glucose concentrations between 5-14 mmol/l (100-250 mg/dl) in the dog and 5-17 mmol/l (100-300 mg/dl) in the cat; attain and/or maintain normal bodyweight, and to minimize and/or eliminate polydipsia, polyuria, and polyphagia (if present). In the cat, since clinical diabetic remission may be possible, it is important to monitor for signs of hypoglycemia. Once adequate control is achieved, the animal should be re-examined in one week. If control remains adequate at that time, regular examinations should be scheduled at 3 to 4 month intervals, or whenever the client notes one or more of the following:

- Polydipsia (daily water consumption > 70 ml per kg of body weight for 3 or more days)

- Polyuria

- Inappetance or anorexia, polyphagia

- Loss of body weight or condition

- Weakness and/or dizziness

If control is found to be inadequate, the dose or doses should be re-adjusted as described above. The blood glucose curve may also need to be repeated.

Overdose

If the dog or cat shows signs of hypoglycemia: weakness, confusion, dizziness or seizures, the animal should be re-examined immediately. In mild cases offer the animal its usual food. More serious symptoms can be treated with an oral dextrose solution or corn syrup rubbed on the oral mucosa or an intravenous injection of a 50% dextrose solution.

Contraindications

Caninsulin is not to be administered to hypoglycemic or anorexic dogs or cats. Dogs and cats known to have a systemic allergy to pork or pork products should not be treated with Caninsulin.

Caninsulin Cautions

Animals which present with severe ketoacidosis, anorexia and/or vomiting should be stabilized with short acting insulin before beginning treatment with Caninsulin. Stress and irregular extra exercise must be avoided.

Diabetic control is best achieved in spayed bitches and queens. Therefore, intact diabetic females should be spayed as soon as they are stable enough to withstand the procedure.

The use of progestogens (estrus inhibitors) and long acting glucocorticoids in patients suffering from diabetes mellitus should be avoided.

The concurrent administration of drugs known to lower blood glucose such as oral hypoglycemic drugs is not recommended.

Depending on the etiology of the diabetes mellitus insulin therapy alone may not be sufficient and additional diagnostics and treatment may be required.

Warnings

Avoid contact with eyes. In case of contact, immediately flush eyes with copious amounts of water for 15 minutes. Accidental injection may cause clinical hypoglycemia. In case of accidental injection, seek medical attention immediately. Exposure to product may induce a local or systemic allergic reaction in sensitized individuals. KEEP OUT OF THE REACH OF CHILDREN

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.

Although all adverse reactions are not reported, the following adverse reaction information is based on voluntary post-approval drug experience reporting. It is generally recognized that this method of reporting results in significant under-reporting of adverse drug reactions. It should be noted that suspected adverse reactions listed here reflect reporting and not causality. The following adverse reactions are listed in decreasing order of frequency.

Adverse events in cats include: lack of effectiveness/dysregulation, decreased appetite/anorexia, vomiting, lethargy, death, injection site reaction, hypoglycemia, ataxia, diarrhea, seizures, and polyuria/polydipsia.

Adverse events in dogs include: lack of effectiveness/dysregulation, lethargy, allergic or skin reaction, vomiting, hypoglycemia, injection site reaction, ataxia, decreased appetite/anorexia, seizures, and diarrhea.

Pharmacology

Canine and feline diabetes mellitus is an endocrinopathy resulting from relative or absolute insulin deficiency. Insulin deficiency impairs cellular uptake of glucose and promotes hepatic gluconeogenesis. When the renal threshold for glucose is exceeded, glucosuria results, along with osmotic diuresis leading to polyuria and polydipsia. Unmanaged diabetes results in ketosis, ketoacidosis, and if left untreated, acidosis, coma and death. Most forms of canine or feline diabetes can be successfully managed by controlling hyperglycemia with regular administration of exogenous insulin and dietary manipulation. The amino acid structure of porcine insulin is identical to the amino acid structure of canine insulin and 3 amino acids different from feline insulin.

In dogs, the amorphous fraction of Caninsulin gives a peak of activity at approximately 3 hours and a duration of action of approximately 8 hours. The crystalline fraction gives a peak of activity at 7 to 12 hours and a duration of activity of approximately 24 hours. In cats, Caninsulin has a peak of activity at approximately 4-6 hours post-administration and a duration of activity of 8 to 12 hours. Accordingly, Caninsulin should be administered once daily in dogs and twice daily in cats. However, the times to the peaks and durations of insulin activity from Caninsulin will vary among individual animals.

Storage

Refrigerate at 2-8°C. Store the vial in an upright position. Do not freeze.

HOW SUPPLIED

10 x 2.5 mL vials

10 ml vials

For further information please refer to the Client Information Sheet which can be found at www.intervet.ca

Intervet Canada Corp., Kirkland, QC Canada, H9H 4M7

1 888 306-0069

10-0170INS, 10-0170INS

Revision date 01SEP2010

NAC No.: 12081324

MERCK ANIMAL HEALTH
Intervet Canada Corp.

16750 ROUTE TRANSCANADIENNE, KIRKLAND, QC, H9H 4M7
Order Desk:   514-428-7013
Toll-Free:   866-683-7838
Fax:   Toll-free 888-498-4444; local 514-428-7014
Website:   www.merck-animal-health.ca
Every effort has been made to ensure the accuracy of the Caninsulin information published above. However, it remains the responsibility of the readers to familiarize themselves with the product information contained on the Canadian product label or package insert.

Copyright © 2014 North American Compendiums. Updated: 2014-07-28

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