Answers to FAQ's

What is diabetic clinical remission and when does it occur?

Diabetic clinical remission is a complete or partial disappearance of the clinical signs of diabetes in response to insulin treatment. This is seen not infrequently in diabetic cats with remission rates of at least 25% probably depending on the time between the onset of the diabetes and the start of appropriate treatment.

Remission should not be confused with potential diabetes mellitus seen in female dogs during metoestrus, in which the pancreatic islets are still able to function but signs of diabetes appear as a result of insulin resistance caused by progesterone-induced production of growth hormone by the mammary gland. These dogs are not truly diabetic but can become so if not treated appropriately (ovariohysterectomy/ovariectomy).

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Can Caninsulin be diluted?

Diluting insulin is not advisable. Caninsulin for example, is a mixture of amorphous (soluble) insulin and crystalline insulin. The crystalline part is relatively insoluble which is why the insulin activity lasts more than a few hours. Caninsulin has a balance between the amorphous and crystalline parts. If insulins are diluted, the balance between amorphous and crystalline parts is no longer 30% and 70%, relatively speaking. The amount of soluble insulin is increased by the aqueous diluent used. This results in a larger aqueous fraction and smaller crystalline fraction.

In addition the stability of the suspension is unknown if Caninsulin is diluted. Caninsulin suspension is optimized to maintain the crystalline portion as a salt. If the water content is increased as with dilution, the solution "looks for a new balance" i.e. it is not stable.

What should Caninsulin look like?

Caninsulin is a mixture of two different types of insulin. Normally, after gentle mixing (invert (upend) the bottle several times), Caninsulin will appear uniformly clear to slightly cloudy and should not have lumps or flakes floating in it. If you see clumps or flakes floating in the vial after you have resuspended the product, do not use it.

A small white ring of sediment may be seen in the neck of some vials of Caninsulin. The ring of sediment forms when the product has not been kept stored continuously in an upright position. A small ring of dried out insulin does not affect the quality of the product. Caninsulin should be stored refrigerated and in an upright position.

Always check on the appearance of the Caninsulin before using it!

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Many specialists think the Caninsulin dosage that Intervet recommends is too high and prefer to use two doses per day instead of one. What do you think?

Many specialists now prefer to use twice daily Caninsulin in dogs at a maximum of around 0.5 units/kg per dose. It is thought that this will produce improved control of glucose levels over the 24 hour period. The decision to use once or twice daily Caninsulin must be made on an individual case basis.

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Insulin resistance
This should be suspected if the insulin requirements increase to more than 1.2 units per kg once daily in the dog, or more than 1.2 units per kg twice daily in the cat and particularly if requirements are greater than 2 units per kg! Obvious causes of insulin resistance include obesity but after initial stabilisation these should not result in a dramatic increase in insulin dose requirements.

Remember that some dogs require insulin twice daily. In these animals an increase in dose may not produce an increase in duration of action but precipitate hypoglycaemia and responsive hyperglycaemia. Dogs in which the duration of insulin action is less than 10-14 hours should receive there insulin twice daily, e.g. starting at 0.5 unit per kg twice daily.

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Some diabetic dogs and cats that are well regulated on Caninsulin require periodic increases in their insulin dose. Why does this happen?

It is not unusual for insulin requirements to change with time. This is related to progression of the disease (e.g. alterations in tissue receptors, etc.) and may relate to how well the animal is really controlled within a 24 hour period.

In addition, any change in body weight or exercise pattern will also alter the insulin requirement. Also any intercurrent problem, e.g. nephropathy will affect the required dose.

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If crystallization is seen around the stopper of the vial is the Caninsulin still suitable for use?

Crystals sometimes form around the stopper of the Caninsulin vial. This is normally minimal and seems to be due to transport or storage of the vial in the refrigerator on its side or top. To keep crystallization to a minimum, store the Caninsulin vial upright in the refrigerator. However if a limited amount of crystals do form, Caninsulin is usually fine to use. If you have any concerns about excessive crystal formation around the stopper of Caninsulin vials please contact your local Intervet representative.

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I have an elderly client with a diabetic cat. Can I pre-load insulin doses into syringes to make treatment easier?

There may be a problem with re-suspending the insulin in such small doses and the effect of prolonged contact with syringe materials is unknown. The best thing to do would be to try a couple of days dosing with pre-loaded syringes and see how the cat does. Depending on the response to treatment, you can then decide if pre-loading syringes for your client is viable.

Intervet has Caninsulin syringes available that come with a magnifyer to assist people who have difficulties filling a syringe.

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Is there information about the use of Caninsulin in rabbits?

Caninsulin is not licensed for rabbits.

The following information, which may be useful, is provided by Dr. Thomas Göbel (Kleintierpraxis, Mecklenburgische Straße 27 14197 Berlin.)

Background Information

Diabetes mellitus in rabbits resembles insulin-independent diabetes in humans. Whether insulin secretion is limited, maintained or elevated, tissue sensitivity to insulin is decreased (peripheral insulin resistance), resulting in a relative insulin deficit. The characteristic clinical signs are polydipsia, polyuria as well as polyphagia and weight loss. Occasionally, uni- or bilateral cataracts are observed. There is also glucosuria.

The diagnosis is made based on the history, clinical signs and blood sugar concentrations measuring repeatedly above 300 mg/dl (16.7 mmol/l).

Dosage
The dosage of Caninsulin that is administered to a diabetic rabbit should be based on the level of control of blood glucose concentrations. An initial dose of 1 unit per kg once daily is recommended. On the basis of the efficacy, a higher dose (up to 3 units/kg once daily) or two doses per day can be given. Please take note that higher doses should not be administered for at least 2 days because a clear reaction to the insulin treatment is usually observed only after this amount of time. A higher dose given too soon might cause sudden clinical signs: polyuria, polydipsia and polyphagia, as well as the return to normal of the rabbit. The desired blood sugar concentration is between 120 and 250 mg/dl (6.7 and 13.9 mmol/l). Lower levels increase the danger of hypoglycaemic episodes.

Feeding
The food of rabbits is naturally full of crude fibre; rabbits eat small portions throughout the day. The food of a diabetic rabbit must consist of hay, high quality green forage and little ready-made food. Ready-made food is often very energy rich and contains too little crude fibre. Feeding diabetic rabbits titbits and sweet fruit (e.g. apple, pear and berries) is not advised.

Control
Rabbits that are doing well on insulin treatment should be checked every three months. The blood and urine glucose concentrations should be measured. It is also normal to check the rabbit’s general well being and its diet.

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