Problems with Regulation

For Cases of Poor Glycemic Control

If diabetic regulation is not proceeding as expected or a patient experiences a change in regulation on a sustained dose, it is important to determine if the issue is patient versus product related. It is important to first establish that the product has been handled properly.

Ruling Out Protocol Issues

Discuss the daily routine—are injections and meals correctly timed? See Feeding Schedule.
Ask for a breakdown of exactly what the dog eats—perhaps the dog is receiving too many tidbits or the incorrect diet. See Nutrition.

Ruling Out Storage and Handling Factors

Incorrect storage of insulin or poor injection technique can affect insulin therapy. Have pet parents demonstrate how they inject their pet, and ask the following:

General questions:

Is the insulin being stored correctly?
Is the insulin being mixed properly?
Is the insulin being injected subcutaneously?
Is the injection site being correctly located?
Is the injection site being rotated?

If using a U-40 insulin syringe:

How long has the vial been in use?
Is the correct dose being drawn up into the syringe?
Is a new syringe being used for each injection?
Have the air bubbles been removed from the syringe during dose measurement?

If using VetPen^®:

Is the insulin cartridge inserted into the VetPen properly?
Have the air bubbles been removed from the VetPen cartridge?
Is a new needle being used for each injection?
Is the correct dose being chosen using the dose selector?
Is the release button being pushed down fully so that the dose selector returns to the start line?
Is the movement of the dose selector restricted by the way the VetPen is being held?
Is the needle being held in the skin for at least 5 seconds after the dose selector has returned to the start line?
If answers to these questions suggest an issue with administration or storage, a dosage reduction may be indicated once these issues are corrected.

See proper handling and storage and delivery of Vetsulin for more information.

Antibodies

Antibodies may be directed either against the insulin or against other foreign proteins in the preparation. The presence of anti-insulin antibodies is common and does not usually lead to poor regulation. Antibody production is less likely if homologous insulin (same structure) is given, eg, the porcine insulin (in Vetsulin) has the same structure to canine insulin.

Ruling Out Patient Factors

Perform a glucose curve.
Consider performing laboratory testing to look for causes of insulin resistance (i.e. complete blood count, urinalysis with sediment evaluation, biochemical profile).

Help Your Practice Manage Diabetes Mellitus

View and download resources and tools that will assist your hospital, inform your team, and help with clients.

Client Discharge Form

Create a customized, printable form for clients about their new diagnosis.

Diabetes Resources

Access online tools and more to support staff and pet parents.

View all resources

Read More About Monitoring & Controlling Canine Diabetes

Important Safety Information

Vetsulin^® should not be used in dogs known to have a systemic allergy to pork or pork products. Vetsulin is contraindicated during periods of hypoglycemia. Keep out of reach of children. As with all insulin products, careful patient monitoring for hypoglycemia and hyperglycemia is essential to attain and maintain adequate glycemic control and prevent associated complications. Overdosage can result in profound hypoglycemia and death. The safety and effectiveness of Vetsulin in puppies, breeding, pregnant, and lactating dogs has not been evaluated. See package insert for full information regarding contraindications, warnings, and precautions.

References

Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy. J Feline Med Surg. 2001;3(1):23–30.
Vetsulin^® (porcine insulin zinc suspension) [Freedom of Information Summary]. Millsboro, DE: Intervet Inc.; 2008.
Data on file, Merck Animal Health.
Graham PA, Nash AS, McKellar QA. Pharmacokinetics of porcine insulin zinc suspension in diabetic dogs. J Small Anim Pract. 1997;38(10):434–438.
Martin GJ, Rand JS. Pharmacokinetic and Pharmacodynamic Study of Caninsulin in Cats with Diabetes Mellitus. 2000: Internal Study Report.
Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:539–579.
Tennant B, ed. BSAVA Small Animal Formulary. 4th ed. Gloucestershire, UK: British Small Animal Veterinary Association; 2002.
Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:486–538.
Reusch C. Feline diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1796–1816.
Nelson RW. Canine diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1782–1796.
Burgaud S, Riant S, Piau N. Comparative laboratory evaluation of dose delivery using a veterinary insulin pen. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 121.
Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic dogs. In: Proceedings of the WSAVA/ FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 122.
Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic cats. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 45.
Davison LJ, Walding B, Herrtage ME, Catchpole B. Anti-insulin antibodies in diabetic dogs before and after treatment with different insulin preparations. J Vet Intern Med. 2008;22:1317-1325.
Banfield State of Pet Health 2016 Report. p 12-13.