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View Full Version : Closed Poll: Insulins - NPH and Vetsulin nearly tied


k9diabetes
04-04-2008, 10:05 PM
This poll will display the member's name with their insulin selections.

Please vote even if your dog has passed on.

k9diabetes
01-02-2009, 11:08 AM
Vetsulin / Caninsulin is making a surge to take over the lead! ;)

bowens2
01-08-2009, 08:39 PM
Can't believe Monkey does so well on Lantus and no one else uses it. But it is hard on the pocket book.

k9diabetes
01-08-2009, 09:10 PM
It would be interesting to see more dogs try it. But I would not wanted them to get started the way Monk was. I remember that night!

k9diabetes
02-22-2009, 03:47 PM
Of all of the dogs at this forum, I believe one has been regulated on once a day insulin.

Deniselaine
02-26-2009, 03:53 AM
Humulin N. Am I in the dark ages here?

Rusty & mom

We Hope
02-26-2009, 07:20 AM
You fit right in! Humulin N and Novolin N are NPH insulins. ;)

k9diabetes
02-26-2009, 01:09 PM
I couldn't figure out how to move your name, but I moved your vote to NPH.

k9diabetes
04-06-2009, 08:13 AM
NPH has surged back into the lead!! :)

k9diabetes
06-11-2009, 05:32 PM
The NPH group currently lists three dobermans, a golden retriever, a pit bull, a couple of huskies, and a labrador so I really don't know where Devon's vet gets his idea that large dogs don't do well on NPH.

I've seen one Rottie in particular who got very erratic results from Vetsulin.

I just don't think there is any rule like that.

Natalie

snow
06-19-2009, 10:04 PM
The NPH group currently lists three dobermans, a golden retriever, a pit bull, a couple of huskies, and a labrador so I really don't know where Devon's vet gets his idea that large dogs don't do well on NPH.

I've seen one Rottie in particular who got very erratic results from Vetsulin.

I just don't think there is any rule like that.

Natalie

Hi I just saw this, sorry.... I could have written it down wrong at the appointment, too. She said that small dogs often don't do well on Vesulin and I was listening and writing so maybe I made a wrong scribble wouldn't be the first time. She said they have lots of animals who do fine on Vetsulin so she wanted me to stick with it for a bit more, since his first few weeks's dosages were just everywhere from his last vet. She had a point, they were...

k9diabetes
08-15-2009, 09:42 AM
Though we have a more recent insulin poll, I'm bringing this one forward for Jake and any others interested in NPH - feel free to show this to the vet as it shows that at one time we had the same number of dogs using NPH as Vetsulin.

Unfortunately, many vets are not familiar with NPH. I'd like to see that change as NPH is a really good insulin for dogs.

Natalie

CarolW
10-17-2009, 10:40 PM
My Kumbi, Australian Terrier, dx 1 Sept 2006, has been on Novolin ge NPH insulin from the date of his diagnosis. He weighs 19-20 pounds. He's in glowing good health, does really well on this insulin.

Just thought you'd like to know that!

He gets 6.75 units (yes, really! - I use a magnifying glass) twice a day, 30 minutes after his meals (12 hours apart.

Sat, 17 Oct 2009 22:40:04 (PDT)

k9diabetes
12-16-2009, 09:29 PM
I'm updating this in light of the many dogs transitioning to NPH.

Natalie

robertpri
12-17-2009, 07:23 PM
Stockpiling Vetsulin? Some calculation help please.

I read the closed sticky thread on potential Vetsulin shortages and will discuss with vet in the am.

Meanwhile, i cannot find a conversion for IU to ML. My new Vetsulin is 10 ML per vial but can't figure how many days that is worth.


One ML = ? IU?

Since Mik is so sensitive to everything [a butterfly in Asia flips his wings and Mik reacts] I would like to stay with Vetsulin, and need to calculate how much I need.

CarolW
12-18-2009, 07:41 AM
Stockpiling Vetsulin? Some calculation help please.

I read the closed sticky thread on potential Vetsulin shortages and will discuss with vet in the am.

Meanwhile, i cannot find a conversion for IU to ML. My new Vetsulin is 10 ML per vial but can't figure how many days that is worth.


One ML = ? IU?

Since Mik is so sensitive to everything [a butterfly in Asia flips his wings and Mik reacts] I would like to stay with Vetsulin, and need to calculate how much I need.

Geez; I started to reply to this, hit a bad key, fell offline, and lost my reply! So here I go again!

Robert - you're talking about concentration of the insulin. Vetsulin is, by definition, a U-40 insulin, and that means, it has 40 IU per milliliter (ML) of fluid.

So, I guess a 10-ML vial would hold 10 times 40 IU, which would be, 400 IU per 10-ML vial. (I am SO bad with numbers, and you can tell that by the way I wrote that!)

There are some bits about concentration - and some illustrations, first, here:

http://www.coherentdog.org/vek/merrymeasure.php#concentr

and then, in contrast with NPH (Lantus also) - both of those are U-100 insulins - those (U-100 insulins) have 1000 units per 10 ML vial.

Diagrams here:

http://www.coherentdog.org/vek/howbig.php

and here

http://www.coherentdog.org/vek/millicc.php

and here

http://www.coherentdog.org/vek/ccmlruler.php

There are other nutty diagrams as well.

The place is full of all kinds of whimsy - intended to give a kind of intuitive feel for concentrations and the sizes of vials and their contents. I do that kind of stuff precisely BECAUSE I am SO BAD at numbers. You can believe, I triple-checked all that stuff!

Fri, 18 Dec 2009 07:39:45 (PST)

robertpri
12-18-2009, 08:28 AM
Thanks Carol, that was a big help!

The diagrams are a bit overly cutesy, but sticking with the charts begins to makes some sense. And your lay term explanations were actually the best.

Ergo: 10ML vial x U-40 = 400 IU's.
Mik gets 7 IU a day, if he eats well.

So, one vial = 400/7= 57 days of insulin. Or, ~2 months.

Three vials should last 6 months. I have one unopened vial, so will buy two.

And I almost learned the hard way to check the expiration dates, which are printed on the BOTTOM of the box! [idiotic] I had one vial marked 12-2010, and the other marked 02-2010. Luckily, I began using the Feb/10 vial first, but it was only because it was closest to my grasp.

CarolW
12-18-2009, 08:52 AM
Thanks Carol, that was a big help!

The diagrams are a bit overly cutesy, but sticking with the charts begins to makes some sense. And your lay term explanations were actually the best.

Ergo: 10ML vial x U-40 = 400 IU's.
Mik gets 7 IU a day, if he eats well.

So, one vial = 400/7= 57 days of insulin. Or, ~2 months.

Three vials should last 6 months. I have one unopened vial, so will buy two.

And I almost learned the hard way to check the expiration dates, which are printed on the BOTTOM of the box! [idiotic] I had one vial marked 12-2010, and the other marked 02-2010. Luckily, I began using the Feb/10 vial first, but it was only because it was closest to my grasp.

Robert - yeah, about the cutesy! Some people need to be urged to laugh, instead of to cry, and that's the initial purpose of the cutesiness. However, I get carried away, which is pretty obvious!

I REALLY, REALLY, REALLY work at trying to do lay explanations that make sense, and at the same time, stay accurate. That can get immensely tricky! So I'm very glad you found them useful.

I have more thoughts about the expiration dates, though. Yeah, idiotic to have them on the bottom!

However! Those are intended to be for shelf-life, BEFORE "opening" the vial.

Once you open a vial (by puncturing the rubber stopper for the first time), the expiration date - the life of the insulin in the vial - changes.

It's now typical for that to be from 28 to 30 days.

Reason: we introduce air into the vial - a possible source of minor contamination.

We mix the stuff, perhaps not always perfectly evenly, so when we withdraw insulin, the percentages of the remaining insulin in the vial may change slightly.

There are other reasons; I can't think of them offhand, but Natalie will be familiar with them, and so might others. The question becomes for you, how far can you safely depend on a vial, once opened? - for how long?

In the current situation, I guess I'd be tempted to try to continue using the same vial longer than its expected life. Have to keep one eye on that potency!

I think (crying now) two months might be too much to expect.

Let's see what others have to say about that.

Fri, 18 Dec 2009 08:50:36 (PST)

robertpri
12-18-2009, 09:39 AM
However! Those are intended to be for shelf-life, BEFORE "opening" the vial.

Once you open a vial (by puncturing the rubber stopper for the first time), the expiration date - the life of the insulin in the vial - changes.

It's now typical for that to be from 28 to 30 days.

In the current situation, I guess I'd be tempted to try to continue using the same vial longer than its expected life. Have to keep one eye on that potency!

I think (crying now) two months might be too much to expect.



Wow! I had NO idea! More new information the vet never mentioned, nor is this noted on the documents.

So, the date does not mean "expiration"
And only 30 days for a vial...?

This might explain why Mik's numbers have been so erratic over the earlier months. When his appetite was zero, he was only getting 2-3 IU a day. In theory, my vials could have lasted 150-200 days!

I never used them that long, but I certainly used them longer than 30 days!

I will add this testy comment to my vet visit today!

robertpri
12-18-2009, 09:47 AM
Robert - yeah, about the cutesy! Some people need to be urged to laugh, instead of to cry, and that's the initial purpose of the cutesiness. However, I get carried away, which is pretty obvious!



OMG! I didn't realize until going back to that site that it's yours. Sorry about the "cutesy" comment. My apologies. That's a lot of work and we thank you.

bob

CarolW
12-18-2009, 11:38 AM
Wow! I had NO idea! More new information the vet never mentioned, nor is this noted on the documents.

So, the date does not mean "expiration"
And only 30 days for a vial...?

This might explain why Mik's numbers have been so erratic over the earlier months. When his appetite was zero, he was only getting 2-3 IU a day. In theory, my vials could have lasted 150-200 days!

I never used them that long, but I certainly used them longer than 30 days!

I will add this testy comment to my vet visit today!

Yes; that could explain erratic numbers. It seems somehow, the information about the life of insulin in a vial, once opened, often goes missing, between vet and client.

That's too bad, because we need to know these things.

Fri, 18 Dec 2009 11:37:30 (PST)

CarolW
12-18-2009, 11:52 AM
Bob - relax; HAHAHA!

OMG! I didn't realize until going back to that site that it's yours. Sorry about the "cutesy" comment. My apologies. That's a lot of work and we thank you.

bob

I couldn't POSSIBLY object to a true remark like that! On the contrary, it gives me faith in your ability to observe. Which all of us really need.

Yes it IS a lot of work. Tons of it. That silly stuff does seem to help some people relax. Others, it must surely turn off!

But it does seem to help stop the crying that is so very common when people first get the diagnosis of diabetes in their dogs. Maybe we women are especially subject to that. It didn't happen to me, because my vet gave me all the information I needed. I DID feel very much overwhelmed, and did shed a few tears (as in, "How can I do this!" - for me, it was largely a financial issue.)

But there are so many vets, it seems, who don't have much experience with diabetes, or who don't instruct clients fully. I'm just lucky that my vet is so great.

And - there are times when I feel close to overwhelmed. I can't afford to become really overwhelmed - it wouldn't be good for Kumbi. (And YOU have done a magnificent job, all along, with Mik.)

robertpri
12-18-2009, 04:51 PM
I couldn't POSSIBLY object to a true remark like that! On the contrary, it gives me faith in your ability to observe. Which all of us really need.

Yes it IS a lot of work. Tons of it. That silly stuff does seem to help some people relax. Others, it must surely turn off!

But there are so many vets, it seems, who don't have much experience with diabetes, or who don't instruct clients fully. I'm just lucky that my vet is so great.



It was still a stupid remark. Anyone who works that hard should be applauded, so I do apologize. On that note, I used to write fiction novels, and got both love and hate fan mail. So, I should know better.

I met the vet at the perfect time today. No clients. Even the nurses were doing busy work, so our chat quickly became five people as three nurses and aids joined in.

1: He is well aware of potential Vetsulin shortage and is already stocking up.
2: He is more concerned with his cat patients about this shortage. Seems their "change over" to another insulin is more difficult.
3: He agreed to the 30 days rule on a vial. ["So why didn't anyone tell me this before?"...and.."Why doesn't the Vetsulin docs say this?"]
4: Ignoring the 30 day rule, at what point does one toss a out vial? 1/2 remaining? 1/4 remaining? 1/8? 1/16?

This generated a long discussion, oddly enough, mostly by the nurses and aids who deal with clients as much as the vet. Perhaps more.

My theory:
If the insulin mix is supposed to be 70/30, but the hand/vial rolling is not fully effective, the injection mix could be 68/32. Or 66/34. Or Worse.

As you get below the middle of the vial, and certainly toward the bottom, then mathematical principles will apply to reverse those numbers. So instead of 70/30, you get 72/28. Or 74/26. Or worse.

Therefore, IMHO, and assuming your hand/vial rolling remains constant, you probably should not use a vial below the 1/4 full point.

You can't alter math, so the poor mixture at the beginning of the vial will have "X" effect on the dog, but will have reverse "Y" effect toward the end of the vial. But if you switch to a new vial, you will not get the reverse effect.

This generated a lot of discussion, but the vet finally agreed.

One aid gave me the Vetsulin phone number because another client had raised that same issue. She had called and the Vetsulin rep "sort of agreed" but insisted that if you hand roll properly, this won't happen.

However, again, IMHO, I don't really know if I am rolling and getting the mix exactly right. So, I am tossing Vetsulin when it has only 1/4 remaining.

She then produced a 2.5 ML bottle instead of the 10 ML bottle. ["And why didn't anyone mention this size before?"]

The 10 ML is $32 and the 2.5 ML is $18.

But if I can only use them 30 days and toss them when only 1/4 remains, I am better off with the more expensive smaller size.

So, that is what I bought.

Sorry for the length of this post, but I am STILL PO'd that these critical things were never explained to me when Mik first went on Vetsulin.

Once again, I have this site and the wonderful members to thank.

And Mik thanks you too!

k9diabetes
12-18-2009, 09:33 PM
I personally am not a big believer in automatically throwing out a vial after 30 days. I know many people who have effectively used the vials longer than that, including Kathy with Lucky.

I would agree that the more they have to be mixed and drawn from, the more likely that the concentration can change over time. And that the better your skill in mixing them carefully, the more likely they are to last.

Storage could be a factor too... a fridge that's too warm or too cold, for example, might influence how well they keep.

At the same time though, if you are withdrawing small numbers of units, you also are making very small changes, if any, to the mixture. When you withdraw 3 units from a bottle that holds 1,000 units, even if you haven't mixed it exactly right, it's not going to make much of a difference in the overall concentration of the solution.

So I don't see automatically throwing insulin out after 30 days as a requirement.

Similarly, Kathy has had a lot of experience with people who stockpiled Humulin L and other discontinued insulins and used them well past the expiration date on the bottle. Again, not ideal but when you have a dog who only does well on that insulin and the insulin is no longer available, you do what you have to do. My understanding is that those folks were very successful in maintaining their dogs' regulation on the expired bottles with careful storage.

There are so many variables that I think, as usual, that these kinds of decisions have to be made case by case. There's the natural variablility of a dog's blood sugar, metabolism, stress and other inflammation, injection depth, injection location.

And if you're giving a dog 20 units or 3 units makes a difference in how much a tiny variation in the makeup of the insulin would have on a body of different sizes.

It goes back to trends. If you see a loss of regulation, you start looking at why and the degraded insulin is one of the first things to consider. But there are a lot of reasons for blood sugar variability too...

We did have an advantage with Chris using R as there was no mixing.

Natalie

robertpri
12-18-2009, 10:06 PM
I can't disagree with anything you noted.

The vet said that it's not just the 30 days, but at 2x/day, that's 60 minute holes in the seal. Air and contamination potentially rises with every additional hole, even though they are supposed to seal. And if one is most likely to inject the needle in precisely the same spot over and over, which is very possible, that "could" increase the potential risk for a contamination leak at the enlarging hole.

But during this past year, I have used Vetsulin waaaaay beyond 30 days. At 400 IU's in a 10ML vial and say only 5 units a day, it could theoretically last 80 days. Of course, you can't get those last drops very well, but still well over two months.

Anyway, I am going to try the 2.5 ML vials and see how it goes.

k9diabetes
12-18-2009, 10:44 PM
I'm glad the smaller vials are available for Vetsulin and I'm sure they will work great for Mik. :)

Natalie

peggy0
12-19-2009, 05:06 PM
Hi Robert

I talked to the Vetsulin folks about this and they said it lasts 64 days once opened :) I'm sure the smaller bottles will work better for you

robertpri
12-19-2009, 05:56 PM
Hi Robert

I talked to the Vetsulin folks about this and they said it lasts 64 days once opened :) I'm sure the smaller bottles will work better for you

Now that is GOOD news! It means I can go back to the 10ML vial. I don't like these little 2.5 at all--too small and hard for me to hold.

400/7 = 57 days, so it's perfect!

I will keep the small ones for emergency backup. Expire date is one year away, so that's good.

BestBuddy
12-19-2009, 06:24 PM
The last 6 months that Buddy was on Caninsulin I started using the 2.5ml bottles. We were using 8iu per day (4 + 4) and is seemed a waste to throw out 1/2 the 10ml vial after 30 days. All the info at the time was 30 days or 100 needle sticks so I only ever used the vial for about 35 days.

Jenny

robertpri
12-19-2009, 06:39 PM
The last 6 months that Buddy was on Caninsulin I started using the 2.5ml bottles. We were using 8iu per day (4 + 4) and is seemed a waste to throw out 1/2 the 10ml vial after 30 days. All the info at the time was 30 days or 100 needle sticks so I only ever used the vial for about 35 days.

Jenny

I had heard the 30 day rule, but not the 100 needle sticks. That would normally be 50 days, right?

I am glad PeggyO learned that it's 64 days, but the "100" rule would be 50 days.

Still, using either rule [64 days] or [100 sticks] the 10 ML vial is more economical. if Buddy needed 8/day, that's 50 days. 400/8, so you are there.

What does buddy weigh? Mik weighs 11 lbs and gets 7 IU [ 3 + 4] He consumes more in the PM

CraigM
07-14-2015, 04:04 PM
I wouldn't give this poll much thought, it's from 2009?:)

Craig

jesse girl
07-14-2015, 05:53 PM
the thing i find interesting is the amount of dogs using NPH where vetsulin was widely prescribed at that time

maybe a bit skewed if some voted today more so over vetsulin but i dont think that would have a large impact either way

CraigM
07-15-2015, 08:45 AM
Natalie: You might want to close this 6 year old poll. I'm sure there have been newer polls:)