INSULINS
NPH (Brand Names: Humulin N, Novolin, Reli-on or Protaphane)

Starting Dosage:
 *Usually calculated at ¼ unit per pound and given twice a day
 *Larger dogs need  closer to ½ unit per pound
Example: 40 lb dog = 10 units given 2 times a day (12 hrs apart & after feeding)
Storage:
 * Unopened vials should be kept in the refrigerator (always look at expiration date)
 * Opened vials maybe kept at room temperature out of sunlight (effectiveness varies but normally replace with
fresh vial after 28 days)
Syringes Recommended:
 *Ultra thin 31 gauge 1/2 cc 5/16” short needle
 *Can be purchased on-line without a prescription at http://www.hocks.com

VETSULIN 

In July of 2008 Vetsulin changed their recommended starting doses.
It has been cut by half and the supplement dose has been eliminated.
The following is the new recommended dosing.
Starting dosage for dogs:
 *Vetsulin dosage varies based on the weight range of the pet and whether the pet receives one or two shots per day.

Dog 
INITIAL RECOMMENDED VETSULIN DOSE IS 0.5 UNIT INSULIN PER KG  OF BODY WEIGHT, 
There are 2.2 pounds per kg so this means one half  unit of insulin for every 2.2 pounds of body weight.
Divide your dog's weight in pounds by 2.2 to determine his weight in kg.
example: Queenie weighed 22 lbs. or 10 kg (22 lbs. divided by 2.2 is 10 kg.)
so her recommended starting dose would be 5 units

Avoiding hypoglycemia 
Hypoglycemia is a major concern. To help avoid it: 

The dog's body weight should be rounded down to the nearest whole kilogram 
The calculated dose of insulin should be rounded down to the nearest  whole unit 

Some Examples of Starting Doses for ONE shot of insulin per day for dogs prescribed vetsulin.
Remember your veterinarian might have a reason for giving less or more then the recommended starting dose.

Body Weight	0.5 unit per kg or 2.2 lbs
4 kg or 8.8 lbs	2 units
5 kg or 11 lbs	2 units
6 kg or 13.2 lbs	3 units
7 kg or 15.4 lbs	3 units
8 kg or 17.6 lbs	4 units
9 kg or 19.8 lbs	4 units
10 kg or 22 lbs	5 units
11 kg or 24.2 lbs	5 units
12 kg or 26.4 lbs	6 units
13 kg or 28.6 lbs	6 units
14 kg or 30.8 lbs	7 units
15 kg or 33 lbs	7 units
20 kg or 44 lbs	10 units
21 kg or 46.2 lbs	10 units

Twice-daily therapy should be initiated if the duration of insulin action is determined to be inadequate. If twice-daily treatment is initiated, each of the two doses should be 25 percent less than the once-daily dose required to attain an acceptable nadir.

For example, a 20-kg dog would receive 10 IU of Vetsulin once daily or 7 IU of Vetsulin administered twice daily
and you would give this twice a day twelve hours between each shot.

CAT - VETSULIN
Cats: Vetsulin dosing and administration
Dosing overview
Starting Dosage:
For cats, the initial recommended dose of Vetsulin® (porcine insulin zinc suspension) is 1 to 2 IU per injection. Cats should be started on twice-daily (BID) injections of Vetsulin at 12-hour intervals. Note that in cats, Vetsulin dosing is calculated on a per animal basis; in contrast, initial dosing for dogs is based on body weight.

Vetsulin should be mixed by gently rolling the vial between your palms prior to withdrawing the dose. Using a U-40 insulin syringe, administer injections subcutaneously, 2 to 5 cm (3/4 to 2 in) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides.

In cats, initially administer twice-daily doses 12 hours apart concurrently with or right after meals fed twice daily. (No change in feeding schedule is required for cats fed ad libitum.) Reevaluate the cat at appropriate intervals and adjust the dose based on clinical signs, urinalysis results, and glucose curve/spot check values until adequate glycemic control has been attained

Storage:
* Opened and Unopened vials should be kept in the refrigerator (always look at expiration date)
* Opened vials should normally be replaced with fresh vial after 28 days)

Syringes Recommended:
* U-40 syringes
* Can be purchased at your veterinarian's office or on-line without a prescription at http://hocks.com

Caninsulin
Caninsulin has left their recommended starting doses the same as before.
Starting Dosage:
In dogs, the initial daily dose is 1 IU per kg bodyweight plus a body weight dependent supplement dose.

In cats, the initial daily dose is 0.25-0.5 IU/kg twice daily, with a maximum dose of 2 units twice daily in the first week. Especially in obese cats, an unduly high starting dose may be dangerous

Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose by approximately 10% per day according to the results of measurement of the glucose concentrations in the blood. Alterations in dose should not normally be made more frequently than every 3-4 days.

Storage:
* Opened and Unopened vials should be kept in the refrigerator (always look at expiration date)
* Opened vials should normally be replaced with fresh vial after 28 days)

Syringes Recommended:
* U-40 syringes
* Can be purchased at your veterinarian's office or on-line without a prescription at http://hocks.com

PZI and Lantus (insulin for felines both have about the same action)
Starting Dosage:
* 0.25 units per pound twice a day for BG numbers 360 or greater and 0.10 Units per puund for BGs less than 360.
Example:
For a 10 pound cat 2.50 units twice daily for blood glucose greater than 360
For a 15 pound cat 3.75unit twices daily for blood glucose greater than 360
For a 15 pound cat 1.50 units twice daily for blood glucose less than 360
For a 10 pound cat 1.00 unit twice daily for blood glucose less than 360
Storage:
* PZI and Lantus should be kept in the refrigerator (always look at expiration date)
* Opened vials of PZI have a shelf life of 30-90 days and Lantus 30 days. 
  (home testing will help you best determine effectiveness)
Syringes Recommended:
* U-40 syringes for PZI and U100 syringes for Lantus
* PZI syringes can be purchased on-line without a prescription at http://hocks.com *Lantus need a prescription.

How Much Insulin to give if Pet Not Eating
NPH or Vetsulin users
*  No food eaten at all then give 1/3 dose of the insulin
*  1/2 of meal eaten then give 1/2 dose of the insulin
*  3/4 of meal eaten then give 3/4 dose of the insulin

PZI  or Lantus users
* Per PZI Vet if your cat hasn’t eaten in 12-24 hrs, do not administer any insulin and contact your vet!

Diet/Nutrition:
NPH users should look for low- fat / high protein diets (either home-cooked or commercial)
Vetsulin Users should have diets with additional carbs because of peaking action
PZI /Lantus Users should benefit from high protein diets
*Our web-site list has a section devoted to nutrition/calories/etc

Recommended Treats:
* Because your pet now has diabetes does not mean they can’t have treats anymore. There are many suggestions on our web site and you have easy links to go to on the web-site reference sheet you were sent if you are a member of our email group.
* Quick suggestions would be: frozen green beans, bits of skinless chicken, small amounts of cooked chicken livers, pure pumpkin (unsweetened!).
*Our web-site list has a section devoted to nutrition/calories/etc

Reactions to look for:
Too much insulin (Hypoglycemia/ “hypo”)
Symptoms:
* Lethargy/weakness
* Head tilting
* Restlessness
* Hunger
* Shivering
* Convulsions or seizures
* Coma
* Glassy eyes
What to do with mild /moderate cases of hypoglycemia
* Rub corn syrup (Karo syrup) on gums
* Mix corn syrup in food if pet will eat
* Watch pet for several hours to make sure a hypo does not re-appear
* Insulin should be reduced by 25% and monitored until an accurate insulin dosage can be made.
* Contact your veterinarian.
What to do with severe cases of hypoglycemia
* Administer corn syrup on gums immediately
* Do not put liquid directly in pet’s mouth (possibly causing choking) & don’t put fingers inside the pet’s teeth if seizing)
* Call your vet immediately
Too much insulin (Somogyi / “rebound”)
Symptoms:
* With urine testing the morning test is persistently “high”
* The morning urine test is “high”, the afternoon test is “negative and the evening test is again “high”
* With blood testing when you get bg levels below 65 followed by 330 within 24 hrs.
* Very strange, inconsistent blood curve results
What to do when rebound is suspected
* Decrease insulin dose (usually 25% reduction per shot recommended)
* Stay on lowered dosage for 2-3 days monitoring results

Ketoacidosis (DKA)
Symptoms:
* Weight loss
* Loss of appetite
* Thirst
* Frequent urination
* High levels of ketones in urine (you can test this with keto-diastix)
* High blood-sugar levels
* Acetone odor/fruit sweet smell
* Hard time paying attention
* Confusion
What to do when DKA is suspected
* Your pet should immediately see your veterinarian.
* Depending on the severity of the DKA your vet’s treatment may include using a short-acting crystalline insulin, as fluids need to be replaced an intravenous fluid maybe used; an adjustment in insulin dosage will likely happen.
What you can do to prevent DKA
* There is no specific method for preventing DKA but careful monitoring is important
* Urine testing gives a pet owner the ability to catch the onset in the beginning
* Finding a diet that eliminates high fat foods
* Be especially watchful if a steroid is used as a treatment for your pet

Finally:
Print this article out and take it to your veterinarian.

Read the webpages found at:
 www.petdiabetes.com
 www.caninediabetes.org
All the webpages from www.petdiabetes.ORG are now located on this website.
 http://www.caninediabetes.org/pdorg/
 

Join an email list for owners of diabetic pets so that you can receive support from others in the same situation.
How to join an email list
 http://www.caninediabetes.org/maillists.html