Vetsulin® (porcine insulin zinc suspension)

FAQs for Dogs

Vetsulin^® Frequently Asked Questions

DIABETES MELLITUS IN CATS

VETSULIN®

VETPEN®

MANAGEMENT OF DIABETES

GENERAL

DIABETES MELLITUS IN DOGS

What is diabetes mellitus and what causes it?

Diabetes mellitus (sugar diabetes) occurs when a dog has inadequate levels of or an abnormal response to insulin, which results in excessive glucose (sugar) in the blood. Dogs with complete or partial lack of insulin are diagnosed with diabetes.
Diabetes Mellitus can develop from disorders of the pancreas, from other diseases, or from the presence of other hormones.

Are diabetes insipidus and diabetes mellitus the same thing?

No. Diabetes insipidus, also known as water diabetes, is caused when large amounts of dilute urine are produced. It is a far less common condition than diabetes mellitus, known as sugar diabetes. Diabetes insipidus is caused by problems in part of the brain or in the kidneys. There is no glucose present in the urine of animals with diabetes insipidus.

What signs do dogs with diabetes typically show?

The most common signs of diabetes mellitus in dogs are:

Increased thirst
Excessive urination
Excessive appetite
Weight loss
General signs, such as lethargy and poor coat condition

What do the terms polyuria, polydipsia, and polyphagia mean?

Polyuria is the production of larger than normal amounts of urine in a given period. Polydipsia is excessive thirst. Polyphagia is excessive hunger.

My dog is having problems holding her urine; does that mean she has diabetes?

No, your dog could have a bladder or kidney infection, or some other medical problem. If your dog is having problems holding his or her urine, you should schedule a trip to your veterinarian as soon as possible.

How is diabetes diagnosed?

Your veterinarian will measure your dog’s blood glucose and test your dog’s urine for the presence of glucose and ketones. Persistently high blood glucose levels along with glucose in the urine usually means that your dog has diabetes mellitus.

Are all dogs susceptible to diabetes?

Dogs of all ages can get diabetes, although it’s most common in older dogs. Obesity, genetics, and other conditions can contribute to the development of diabetes.

How many dogs currently have diabetes?

While believed to be underdiagnosed, diabetes mellitus affects an estimated one in 1 in 300 dogs.¹

What side effects are associated with diabetes?

The most common problems associated with pet diabetes include recurrent infections and cataracts in dogs. Cataract surgery is available for canine diabetics and often can restore vision.

What other diseases have the same signs as diabetes?

Other diseases that have the same signs of diabetes are:

Increased thirst
Excessive urination
Excessive appetite
Weight loss
General signs, such as lethargy and poor coat condition

Did I do something to cause diabetes?

No. Diabetes is due to a lack of insulin produced by the pancreas. Diabetes in dogs is thought to be an autoimmune disease. It is not caused by a virus or infection.

What is the difference between Type 1 and Type 2 diabetes?

Type 1 diabetes is caused by the destruction of cells in the pancreas that produce insulin. Dogs with diabetes almost always have Type 1, and require insulin therapy to manage. In Type 2 diabetes, the pancreatic cells produce inadequate amounts of insulin or there is resistance to the insulin that is produced. Cats are more frequently diagnosed with Type 2 diabetes. Cats can be classified as Type 2 diabetes, and do not always require insulin therapy.

What is the expected lifespan for a dog with diabetes?

With proper care and management of their disease, dogs with diabetes can have a lifespan similar to non-diabetic canines.

Is diabetes in animals similar to that of humans?

Yes, it is very similar. Your dog will be using similar medications, equipment, and monitoring methods as human diabetics use, though treatment goals may be different.

VETSULIN®

What is Vetsulin®?

The first insulin approved by the US Food and Drug Administration for treating both canine and feline diabetes mellitus. Vetsulin is produced by Merck Animal Health and is available only by prescription.

Is this a brand new insulin?

No, Vetsulin is registered in over 30 other countries as Caninsulin®. It was first registered in Australia in 1990, so there is a history of more than 25 years of safety and efficacy with this product.

Is Vetsulin made in the US?

No, Vetsulin is manufactured by Merck Animal Health in Germany.

Can Vetsulin be diluted?

No. If Vetsulin is diluted the dosage of insulin would be wrong.

Does Vetsulin really need to be shaken? Why didn’t I have to shake my dog’s previous insulin product?

Vetsulin is a suspension of two insulin types – an aqueous and crystalline part. Shaking is the best way to make sure these are properly mixed and that your dog receives the right amount of insulin.

Can I use U-100 syringes with Vetsulin?

No, use of a syringe other than a U-40 syringe will result in incorrect dosing and it could be fatal.

How often does Vetsulin need to be given to dogs?

This can differ depending on your dog, but typically dogs only need one to two doses per day. Careful monitoring will help your veterinarian determine the correct frequency for your dog. If a 2nd dose is to be administered, each individual dose should be 25% lesser than if it were administered only once.

Where on my dog’s body should Vetsulin be injected?

Injections should be given subcutaneously (under the skin) about 1 to 2 inches below the spine. Constantly vary the injection location from behind the shoulder blade to just in front of the hip bone, and alternate injections between your dog’s left and right sides. Your veterinarian can show you the recommended locations for injections.

Download the Administration Sheet for instructions on how to give Vetsulin to your dog.

Can I still use a vial of Vetsulin if it freezes?

No, freezing will damage the insulin molecules and reduce the efficacy of the product. If a vial of insulin accidentally freezes in the refrigerator, it should be discarded and a new vial should be used.

Can I still use a vial of Vetsulin if it was forgotten outside the refrigerator between doses?

Ideally, Vetsulin should be stored upright, protected from light, between 2°C and 8°C (35°F and 46°F). Vetsulin should always remain refrigerated. If you accidentally leave a vial out of the refrigerator, contact your veterinarian for instructions.

What else should I know about Vetsulin?

Always have a spare vial on hand
Protect it from light
Keep it refrigerated
If it has gotten too hot, or frozen, discard it immediately
Discard contents after 42 days of the first vial puncture
Before drawing up a dose, shake the vial thoroughly until a homogeneous, uniformly milky suspension is obtained

Should I feed my dog before or after an injection?

It is very important that your dog eats before you give the injection of Vetsulin.

How do I dispose of insulin syringes?

The guidelines for each community are different. You will need to check with your own. All syringes should be disposed of in an appropriate sharps/biohazard container

VETPEN®

What makes VetPen® unique?

While insulin pens have been commonly used in the management of human diabetes for some time, VetPen is the first device designed for use in dogs with diabetes. Previously, the only approved way to give Vetsulin injections was to use vials and syringes, which some pet parents found inconvenient and overwhelming. While human insulin pens are used to give insulin with a concentration of 100 IU per mL, VetPen works specifically with 40 IU per mL Vetsulin, which is tailor-made for use in pets.

Is VetPen difficult to use?

VetPen is ergonomically designed to make handling easy and the dosing process simple. It also reduces the time it takes to prepare and give insulin injections. It’s easy enough to use even for pet parents with poor eyesight, arthritis, or any other condition that may cause unsteady hands

How do I measure insulin doses with VetPen?

The all-in-one construction of VetPen allows you to take it with you while away from home and makes it easy for you to give your pet her insulin nearly anywhere. The VetPen Starter Kit includes a handy travel pouch that holds the VetPen, needles, needle remover, and insulin, as well as the Dose Selector Adaptor and Release Button extensions.

What type of needle is used with VetPen?

VetPen uses 29 gauge, 12mm pen needles only, which are small, thin, and specially lubricated. These are the only needles that should be used with VetPen. Always use a new needle for each injection.

Can VetPen needles be reused?

A new needle should be used with each injection. The needle should be removed with the needle remover and safely disposed of immediately after use. Reusing a needle may lead to insulin contamination, needle blockage, and/or inaccurate dosing.

Is VetPen reusable?

Yes. VetPen uses a replaceable insulin cartridge that allows multiple doses to be provided with minimal preparation time. When all the insulin has been used, simply remove the empty cartridge and insert a new one. After inserting a new cartridge, it is important to prime the VetPen prior to use. (See instructions for Priming the VetPen)

Can VetPen be used with different insulins?

VetPen has been designed specifically for use with Vetsulin. To avoid dosing errors, other types of insulin cartridges for other types of insulin should not be used with VetPen.

Does VetPen offer any other benefits over traditional insulin vials and syringes?

VetPen helps enhance use by:

Lowering the risk of accidental needle stick injuries
Protecting the insulin cartridge from breakage
Reducing the likelihood of insulin spills
Reducing air bubbles that lead to inaccurate dosing
Selecting doses more accurately

Why does the VetPen need to be tested before each injection?

It is important to confirm that the VetPen and the needle are working properly to ensure that the pet receives an accurate dose of insulin. To do so, measure a small dose and ensure that the insulin flows freely through the needle.

What should the insulin cartridge look like after mixing and priming?

Each cartridge contains 2 glass beads to help with the mixing of the Vetsulin before use. The cartridge should be thoroughly shaken before inserting it into the VetPen. After shaking, the insulin should appear uniformly milky. Do not use the cartridge if clumps persist after shaking thoroughly. Do not mistake the glass mixing beads for air bubbles, which should be removed during priming.

How do I know when the injection is complete?

To make sure the pet’s dose is injected precisely and accurately, you need to hold down the release button until the arrow (►) points to the start line (–) on the dose selector. Then, wait at least 5 seconds before removing the needle from the skin. This allows for VetPen’s internal mechanism to optimally deliver the selected dose.

What if there is not enough insulin in the cartridge to complete an injection?

You can tell how many units of the dose were not given by looking at the number where the dose selector stopped. You may need to give the remainder of the dose. If so, write that number down.

Put in a new cartridge, prime (remove air from cartridge), and prepare the VetPen for use. Then, turn the dose selector to the number you wrote down and inject the pet as usual.

How do I take care of VetPen?

VetPen should always be stored or carried with the needle removed and the cap on. To clean VetPen, simply wipe with a damp cloth. Do not immerse it in water. Keep Vetsulin cartridges refrigerated and protected from light prior to use. Do not freeze.

What should I do if my VetPen isn’t working?

If you are experiencing any issues using VetPen, the first step is to confirm that air was properly removed from the cartridge through priming. If this has been done, check the other Q&As for more troubleshooting help.

What if insulin drips actively from the needle after injection?

This may be a sign the needle may have been removed before the injection was completed, and your dog did not receive the full dose.

To make sure your pet receives his or her full dose, be sure to press the release button down fully and hold it until the arrow (▶) points to the start line (–) on the dose selector. Then, to allow the VetPen to deliver the full dose, wait at least 5 seconds before removing the needle from the skin.

What if the dose selector does not return to the start line after testing VetPen?

There are 4 likely causes for this

The release button is not fully pushed toward the needle. This can prevent the dose from being released completely. Be sure to push the release button down fully during each injection so that the dose selector can rotate back to the start line. Then, wait at least 5 seconds before removing the needle.
You’re closing your hand too tightly around the dose selector. This can prevent it from fully rotating back to the start line. Avoid this by holding the VetPen like a pen so that the dose selector is able to rotate freely after the release button has been depressed.
The needle is blocked. Replace the needle on VetPen with a new one. It is important to use a new needle for each injection for hygiene and safety reasons.
The cartridge did not have enough insulin for the full dose. If the cartridge is empty, replace it with a new one and complete the priming process.

What if a dose too large for the pet is selected?

If too high a dose has been selected, it is very important not to try to turn the dose selector back to a lower dose. This can damage or break the VetPen. Instead, release the insulin through the needle into a tissue or swab by pressing the release button. Then select the correct dose.

What if no insulin drips actively or squirts from the needle after priming or preparing for use?

There are 2 likely causes for this:

The needle is blocked. To fix, replace the needle with a new one. Remember to use a new needle for each injection.
The cartridge plunger is stuck. To fix this, place the protective cap back onto the needle and unscrew the cartridge holder. Then slide the release button towards the internal plunger and hold it until the arrow points to the start line. Dial 2 units without screwing the device back together, then push and hold down the release button until the arrow points to the start line. Without rewinding the internal plunger, screw the cartridge holder and the VetPen body back together. This should release the cartridge plunger and expel some of the insulin.

MANAGEMENT OF DIABETES

What if I missed a full dose or part of an injection?

If you missed a full or partial dose, it is best to wait until the next insulin dose is required and then continue as normal. A brief period of high blood sugar (hyperglycemia) due to too low an insulin dose is not as dangerous as the possibility of causing low blood sugar (hypoglycemia) by giving too much insulin.

What if I think I’ve given too much insulin?

Contact your veterinarian and explain the situation. Your veterinarian may recommend feeding your dog extra food. Monitor your dog carefully for signs of low blood sugar (hypoglycemia):

Hunger
Restlessness
Shivering
Unsteadiness
Very quiet or sleepy

If you see any of these signs, try to encourage your dog to eat a small meal, or rub some corn syrup on your dog’s gums.

What if I think my dog has very low blood sugar (hypoglycemia)?

The following signs may indicate hypoglycemia:

Restlessness
Trembling or shivering
Unusual movements or behavior
Unusual quietness or sleepiness
Loss of consciousness (coma)

If your dog is conscious, you should immediately treat your dog by pouring a small amount of a sugar solution (like corn syrup) onto your finger and then rubbing it onto your dog’s gums. The sugar is absorbed very quickly and your dog should respond in 1–2 minutes. The sugar solution should never be poured directly into your dog’s mouth since there is a risk that the solution will be inhaled into the lungs. Once your dog has responded to the sugar and is sitting up, it can be fed a small meal. Once stabilized, your dog should be transported to your veterinarian for evaluation.

What is stress hyperglycemia?

Stress hyperglycemia is caused when a dog is frightened or stressed. Glucose in the urine is usually absent with stress hyperglycemia because the blood glucose does not stay high for a long enough period to spill into the urine. Stress hyperglycemia does not influence the diagnosis of diabetes because the blood glucose level does not stay elevated long enough to cause glucose to spill into the urine. Stress hyperglycemia is more common in cats than dogs.

What is fructosamine?

Fructosamine is a type of protein in the blood that can be used to measure glucose control over a longer period. Unlike blood glucose measurements, fructosamine is not affected by stress or the timing of the insulin injection. Your veterinarian may recommend periodic measurements of fructosamine to evaluate how well your pet’s blood glucose level has been controlled over the last few weeks.

How much water should I let my dog drink?

If your dog has diabetes, and drinking excessive amounts of water, give him/her all it can drink. Your dog’s body is trying to combat the high blood glucose level by expelling the excess sugar out of its body through the urine. Once your dog is regulated, this will subside.

What is the importance of making sure my pet is regulated?

If diabetes is left untreated or unregulated it could cause many complications. These include neuropathy, infections, ketosis, and ultimately death.

How long does it take to regulate an animal with diabetes?

There is no way to put a specific time on it since each dog is different. Sometimes the regulation process will require you to try different insulin dosages, diets, or injection frequencies. Regulation can be achieved sometimes within a month, or other times over a year from when therapy first started. It is very important to work closely with your veterinarian during this process to avoid further complications. Even after your dog is regulated, frequent veterinarian visits will be necessary to maintain good health.

What can I give my dog as a treat?

Your veterinarian will be the best person to determine your dog’s diet. Ask about appropriate treats your pet could still enjoy!

What does the typical diet consist of?

To keep constant from day to day, it is best to use commercially produced rather than homemade foods. Certain high-fiber prescription veterinary diets can be a useful adjunct to Vetsulin therapy. These diets should be avoided in underweight dogs with diabetes. If special diets are unavailable, or your dog does not eat the diets, then standard canned dog foods are acceptable. To determine the optimal diet to help your pet maintain a healthy weight and control diabetes, talk to your veterinarian.

What is a blood glucose curve?

This is where the blood glucose is measured every 2 hours through the day. The dog should be on the same food schedule as at home. For most dogs, a 10–12 hour curve is adequate but in some instances a longer curve may be needed. A glucose curve helps you see insulin effectiveness, glucose nadir (the lowest glucose reading), and duration of insulin effect. The insulin dose, frequency of administration and feeding times may be altered based on these results.

What are some problems with blood glucose curves?

The results of the curve can be affected by several factors, and measuring the curve at the veterinarian’s office can give an inaccurate portrayal of what is occurring at home. Not eating or stress (causing hyperglycemia) may occur at the veterinarian’s office. It is advised to feed your dog at home, then take samples until the next meal, in case your dog won’t eat at the veterinarian’s office.

In addition, it is not uncommon for curves to vary from day to day because many things can affect blood glucose levels such as appetite, digestion, metabolism, exercise, hormones, stress, etc., even in well-regulated dogs. Discuss any inconsistencies in your glucose curves with your veterinarian.

How often should a blood glucose curve be done?

Once regulated, a blood glucose curve is done every six months on average. Your veterinarian will advise you on the best frequency for your dog.

GENERAL

My dog is ill and not eating. Should I still give him/her an insulin injection?

If your dog is not eating do not give Vetsulin^® or any other insulin! Consult your veterinarian on how to proceed with insulin injections.

How often should a dog with diabetes see the veterinarian?

If healthy and well regulated, most experts recommend every three months, but your veterinarian will recommend what is best for your dog.

Should my dog with diabetes still receive vaccinations?

It is perfectly safe for a dog with diabetes to receive vaccinations. In fact, it is important to help prevent infectious diseases in your diabetic pet, and this annual visit also gives your veterinarian a good opportunity to give your dog a complete checkup. By keeping your dog healthy, there will be fewer fluctuations in insulin requirements.

Is it safe for a dog with diabetes mellitus to receive a general anesthetic?

Normally animals need to have an empty stomach before they are anesthetized. A dog with diabetes that has not been fed needs far less insulin. Your veterinarian will advise you on how much insulin to give your dog before it is admitted, or may wish to give a reduced dose of insulin for you. Usually a dog with diabetes is given intravenous fluid therapy while under anesthesia. This hydrates the animal when it cannot drink on its own. Apart from needing a reduced amount of insulin and fluid therapy (which is also given to some other animals undergoing anesthesia), your dog is not at any additional risk from anesthesia than a dog without diabetes of the same age.

Talk to Your Vet Today

Find a veterinarian to learn more about pet diabetes, and how cats and dogs can lead a happy, healthy life with proper management.

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References

Canine diabetes mellitus; can old dogs teach us new tricks? Catchpole B, Ristic JM, Fleeman LM,Davison LJ. Diabetologia 48:1948-1956, 2005.

Important Safety Information

VETSULIN® and VETPEN® are for use in animals only. Dogs and cats known to have an allergy to pork or pork products should not be treated with VETSULIN®. VETSULIN® is contraindicated during periods of hypoglycemia. Animals with severe ketoacidosis, anorexia, lethargy, and/or vomiting should be stabilized with short-acting insulin and appropriate supportive therapy before use. As with all insulin products, careful patient monitoring for hypoglycemia and hyperglycemia is essential. Overdosage can result in profound hypoglycemia and death. Progestogen and glucocorticoid use should be avoided. The safety and effectiveness of VETSULIN® in puppies, kittens, breeding, pregnant, and lactating dogs and cats has not been evaluated. Keep out of reach of children. Avoid contact with eyes. In case of contact, immediately flush eyes with copious amounts of water for at least 15 minutes. Accidental injection may cause clinical hypoglycemia. In case of accidental injection, seek medical attention immediately. Exposure to the product may induce a local or systemic allergic reaction in sensitized individuals. For complete safety information, refer to the product label.