What about going from Humulin N to Vetsulin?

[Macadamia Nut]

My 13 yr old Mac (Lab/GSP cross) was diagnosed in April of 2013. Now, in December we are using 16 units of Humulin N twice daily and I'm feeding Hill's Prescription W/D.
So far so good, though once Mac starting feeling better after initial diagnosis and treatment, he became completely intolerant of glucose checks at home, (even the vet says, "he's gotten really squirrely about this, and it takes tow of us t get a glucose.)
So I feel like I'm daily going on faith, rigid adherence to diet and medication, and monitoring his symptoms.

A recent fructosamine test showed his blood glucose to be running at the lowest end of normal for a non-diabetic dog, so per the vet I lowered his dose 1 unit twice a day, and increased his food.

All seems well, but I feel like I won't really know until his next fructosamine test in March, whether we're running high or low

But getting to my question....
Generally I order Humulin N from VetRXDirect.com, because almost none of the local pharmacies carries the Humulin N anymore, but have all moved to Novolin N, and telling me, "It's the same as Humulin, just generic!"
I don't believe this.

Here's where I should mention I'm a registered nurse, which has enabled me to completely and continuously overthink my dog's disease, medication and diet

Now I know from reading that there is a difference between Novolin and Humulin, in terms efficacy in dogs. Humulin tends to be more effective in dogs.
Given this, I've been completely unwilling to use Novolin, or Relion or other Novolin generics, as I felt we'd achieved balance and control on Humulin N, and given Mac's unwillingness to allow me to check his blood sugar, it wasn't worth it to switch to Novolin, or Relion.

However, my research also showed that dogs respond best to Porcine insulin, as it is almost identical in chemical structure to their own. The problem is porcine insulin has been unavailable in the US for at least the last 10 yrs.

I recently ordered some supplies from Drs. Smith and Foster (from the website,) and noticed they sell insulin, not only Humulin N, but also Vetsulin- a porcine insulin.

I'm wondering if there is a hard, fast Vetsulin to Humulin N dosing ratio or formula?
Does anyone with experience think it's worth my time and trouble to switch to Vetsulin, (aside from the fact that Vetsulin is now being manufactured at a price considerably lower price than Humulin N...and I could realize as much or more than $70/month savings in medication. Not worth it to me if Mac is going to be too difficult to re-regulate on new regimen.)

I consider myself lucky to have a really good working relationship with my vet, and while they also seem to struggle a little with the teaching about diabetes, at no time have I felt they were trying to sell me a bill of goods. They recommend Humulin N because it's the current standard in the treatment of canine diabetes in the US, and they don't have a lot of experience with porcine insulin.

I'm wondering if there's anyone out there with any experience with the porcine product in dogs, and if so, how difficult it was to switch, and the value of doing so.

Ultimately I would consult my vet, as I will need the prescription for the Vetsulin, and I want to keep my vet in the loop. They've been good to me and my animals over the years.

[farrwf]

Re: What about going from Humulin N to Vetsulin?

Novolin is basically the same insulin as Humulin. It's not a generic, ... they're like Chevy and Ford.

It should work just as well, and you can get it at Walmart for $24.88 a 10ml vial.

If your dog is doing great on a nph insulin (Humulin or Novolin) I'd certainly stay in that family of insulins. Why fix something that's not broken. Seems like your pup is doing very well, as is.

[k9diabetes]

Re: What about going from Humulin N to Vetsulin?

Hi,

Wondering where you read the Humulin is more effective than Novolin?

Humulin has been "sold" to vets as better I would guess. By reps for Humulin. So vets tend to be more familiar with Humulin.

Novolin being better or worse hasn't been the forum's experience - generally dogs are like everyone else, what works best for one is a nightmare for another and vice versa.

We have many dogs here using Novolin. I will bring up the poll showing that.

Natalie

[CraigM]

Re: What about going from Humulin N to Vetsulin?

As mentioned, Novolin / Humulin are not generic, they are both brand named NPH insulins made by huge drug companies. Novolin is manufactured by Novo Nordisk, probably the largest diabetes company in the world. Many of us have switched from Novolin-N to Humulin-N back to novolin-N over the years due to the contract at Walmart. For several years Walmart sold Humulin-N for $25, but they switch their contract back to Novolin-N two(?) years ago. My Annie does well on either, so we go with whatever Walmart sells for $25.

Vetsulin returned to the U.S. in either late 2012, or early 2013. Vetsulin might be more like dog insulin, but the expense keeps me away (Annie started on Vetsulin 6 years ago, but shifted to NPH when Vetsulin was removed from sale in the U.S.) Vetsulin is generally going to be much more expensive than the Walmart sold Novolin-N and probably more expensive than your Humulin-N. The reason is that Vetsulin is a U-40 insulin, while Novolin-N / Humulin-N are U-100 insulins so there is 2.5 times less active insulin in the same size vial. So, if Mac is using 32 units of NPH per day that would last 31 days. If Mac switched to Vetsulin he would need a new vial about every 12 days. (both come in 10ml vials)

Craig

[k9diabetes]

Re: What about going from Humulin N to Vetsulin?

What a beautiful dog!

[amydunn19]

Re: What about going from Humulin N to Vetsulin?

I prefer Novolin because the vial lasts longer than Humulin. I never got more than 30 days out of humulin and can stretch my novolin to 45 days if needed. My dog was originally on humulin and i switched to novolin when Wal-Mart changed their contract. I had to adjust her dosage only slightly(about a half unit) because she went just a little lower than with humulin.

If you have success with nph, I would not change to vetsulin. Some dogs don't do that well on vetsulin and I wouldn't mess with anything that already works. One thing I like about nph is that it is readily available any time of the day at any pharmacy. If you drop your bottle of vetsulin, I would worry about it being on a Sunday or holiday. Some people keep an extra vial but I have never liked having lots of back up items just in case plus it is too pricey.

[Macadamia Nut]

Re: What about going from Humulin N to Vetsulin?

Hi,

Wondering where you read the Humulin is more effective than Novolin?

Humulin has been "sold" to vets as better I would guess. By reps for Humulin. So vets tend to be more familiar with Humulin.

Novolin being better or worse hasn't been the forum's experience - generally dogs are like everyone else, what works best for one is a nightmare for another and vice versa.

We have many dogs here using Novolin. I will bring up the poll showing that.

Natalie

Vet said their experience was that dogs require higher doses of Novolin to achieve equivalent results. My dog was started on Humulin, so I've kept him there, despite the price, because stability is golden and worth the extra money to me.

And therein is probably the answer to my own original question

However, I do know in humans and at least anecdotally in dogs, the duration of action can differ by a few hours- Novolin being longer acting by a few hours. I know from curves that my dog is getting an average of 6-8 hours coverage on Humulin, where he might- in theory- get 8-10 hours out of Novolin.

As an aside, I really resent the Walmart pharm techs rolling their eyes and saying, "It's all the same," when research does show differences, and diabetes is a potentially life threatening disease.

ON the human end of things, I think of drugs whose generics could be said to be "the same as the brand name," but studies shows a marked reduction in efficacy with a generic form. There is no accounting for what sorts of chemical buffers different manufacturers use, and the effect of the buffers on the efficacy of the medication, (Budeprion being one example. Although meeting FDA standards, was found completely ineffective compared to it's brand name counterpart.)

Was just thinking if Porcine was therapeutically better for him, it might be worth the trouble to switch. But the idea of essentially starting over at square one is daunting.
Mostly I was curious to know if anyone had made this switch, back to Vetsulin, since it became available again in April 2013.

[Macadamia Nut]

Re: What about going from Humulin N to Vetsulin?

about the compliment on my dog's beauty- Why thank you

[Macadamia Nut]

Re: What about going from Humulin N to Vetsulin?

I prefer Novolin because the vial lasts longer than Humulin. I never got more than 30 days out of humulin and can stretch my novolin to 45 days if needed. My dog was originally on humulin and i switched to novolin when Wal-Mart changed their contract. I had to adjust her dosage only slightly(about a half unit) because she went just a little lower than with humulin.

If you have success with nph, I would not change to vetsulin. Some dogs don't do that well on vetsulin and I wouldn't mess with anything that already works. One thing I like about nph is that it is readily available any time of the day at any pharmacy. If you drop your bottle of vetsulin, I would worry about it being on a Sunday or holiday. Some people keep an extra vial but I have never liked having lots of back up items just in case plus it is too pricey.

That's a really good point, about dropping the Vetsulin bottle on a Sunday. Although I currently buy my Humulin N via mail order because its become impossible to find without special order from local pharmacies.

[Macadamia Nut]

Re: What about going from Humulin N to Vetsulin?

As mentioned, Novolin / Humulin are not generic, they are both brand named NPH insulins made by huge drug companies. Novolin is manufactured by Novo Nordisk, probably the largest diabetes company in the world. Many of us have switched from Novolin-N to Humulin-N back to novolin-N over the years due to the contract at Walmart. For several years Walmart sold Humulin-N for $25, but they switch their contract back to Novolin-N two(?) years ago. My Annie does well on either, so we go with whatever Walmart sells for $25.

Vetsulin returned to the U.S. in either late 2012, or early 2013. Vetsulin might be more like dog insulin, but the expense keeps me away (Annie started on Vetsulin 6 years ago, but shifted to NPH when Vetsulin was removed from sale in the U.S.) Vetsulin is generally going to be much more expensive than the Walmart sold Novolin-N and probably more expensive than your Humulin-N. The reason is that Vetsulin is a U-40 insulin, while Novolin-N / Humulin-N are U-100 insulins so there is 2.5 times less active insulin in the same size vial. So, if Mac is using 32 units of NPH per day that would last 31 days. If Mac switched to Vetsulin he would need a new vial about every 12 days. (both come in 10ml vials)

Craig

Good point, abut U-40 feature of Vetsulin.
However the pricing is now competitive with Novolin, at least on the Drs Foster and Smith website. Around $20-something a 10 ml vial.

I'm paying $99 for a 10 ml vial of Humulin N, and additional Fed Ex shipping, because it has to be refrigerated.
So I buy 2 vials at a time, and pay roughly $219, including shipping.
Part of the reason I was thinking about the Vetsulin, because of the efficacy and increased affordability.

I believe the price of all drugs shoots up when manufacturing is reduced, possibly in response to reduction in demand.
So it was with Vetsulin when they were ceasing sales in US, and now seems to be happening with Humulin, as people switch over to Novolin.

Given Mac's age, and that he's a bigger dog (60#) I'm probably going to keep him on the Humulin, especially after hearing other's input.
If he were younger, I might feel more inclined to really experiment. But he's pretty old for his age/breed/weight. If we make another year, I'd be surprised...and delighted.
All that said, I'm grateful we haven't had to deal with neuropathy and blindness (so far...knock wood.)

[farrwf]

Re: What about going from Humulin N to Vetsulin?

Good point, abut U-40 feature of Vetsulin.
However the pricing is now competitive with Novolin, at least on the Drs Foster and Smith website. Around $20-something a 10 ml vial.

I'm paying $99 for a 10 ml vial of Humulin N, and additional Fed Ex shipping, because it has to be refrigerated.
So I buy 2 vials at a time, and pay roughly $219, including shipping.
Part of the reason I was thinking about the Vetsulin, because of the efficacy and increased affordability.

I believe the price of all drugs shoots up when manufacturing is reduced, possibly in response to reduction in demand.
So it was with Vetsulin when they were ceasing sales in US, and now seems to be happening with Humulin, as people switch over to Novolin.

Given Mac's age, and that he's a bigger dog (60#) I'm probably going to keep him on the Humulin, especially after hearing other's input.
If he were younger, I might feel more inclined to really experiment. But he's pretty old for his age/breed/weight. If we make another year, I'd be surprised...and delighted.
All that said, I'm grateful we haven't had to deal with neuropathy and blindness (so far...knock wood.)

Vetsulin is $39.99 at Foster & Smith, and that's for 400 units of the insulin, which makes it equal, on a per unit cost, to the $99.99 they charge for 1000 units of Humulin from their store.

They charge ~10¢ for a unit of either insulin. The Novolin from Walmart is ~2 1/2¢ per unit.

[k9diabetes]

Re: What about going from Humulin N to Vetsulin?

While it's true that there can be minor differences between the products, it's all kind of academic in the end. Since every dog is different in how they process food and insulin, the studies just don't mean very much.

There are species differences that affect how these insulins are absorbed. Dogs tend - again, generally speaking with a ton of variation dog by dog - to absorb and metabolism insulins somewhat faster than humans and cats absorb and metabolism insulins faster still. Cats are now primarily given very long acting insulins like glargine and detemir.

Consequently, a lot of dogs can get both their basal and bolus blood sugar needs with the one intermediate N insulin.

In fact, some dogs process the insulin so quickly that their blood sugar can plunge in the first couple of hours after a meal and injection as if you had given them some fast acting insulin.

The forum represents a pretty good comprehensive study of dogs' responses to various insulins, and a number of people have had to change insulins either because Vetsulin was pulled from the market or because of the switch in affordable insulin by Walmart. So we have seen a LOT of dogs make the transition and try both products.

The results are simply confirmation of "Every Dog Is Different."

Some dogs did better on Humulin than Novolin. Some dogs did better on Novolin than Humulin. Some dogs can use both equally well. Some dogs don't do well on NPH of any kind...

Back when Humulin L was the standard insulin for dogs, our diabetic didn't do well with it at all. It took him ages to break the insulin out of the packaging and make use of it. Other dogs did so poorly on anything but Humulin L that when it was pulled from the market their caretakers stockpiled refrigerators full of it because it was the only insulin that worked for their dogs.

Belabored probably... point is, studies just really don't mean much to an individual dog.

If you can afford to stay with Humulin and he's doing great on it, I'd stick with it.

If you can't, you could give the Novolin a try and go back to Humulin if it doesn't work as well. We tried a few insulins with our dog before winding up on Regular insulin four times a day. Carefully done, an experimental switch is usually only minimally disruptive.

Natalie

And therein is probably the answer to my own original question

However, I do know in humans and at least anecdotally in dogs, the duration of action can differ by a few hours- Novolin being longer acting by a few hours. I know from curves that my dog is getting an average of 6-8 hours coverage on Humulin, where he might- in theory- get 8-10 hours out of Novolin.

As an aside, I really resent the Walmart pharm techs rolling their eyes and saying, "It's all the same," when research does show differences, and diabetes is a potentially life threatening disease.

ON the human end of things, I think of drugs whose generics could be said to be "the same as the brand name," but studies shows a marked reduction in efficacy with a generic form. There is no accounting for what sorts of chemical buffers different manufacturers use, and the effect of the buffers on the efficacy of the medication, (Budeprion being one example. Although meeting FDA standards, was found completely ineffective compared to it's brand name counterpart.)

[k9diabetes]

Re: What about going from Humulin N to Vetsulin?

Do check out the poll I brought forward. If you click on the results numbers in the column, you can see which members are using which insulin.

Natalie