The Evolution Of Insulin Therapy
Commercial insulin has evolved over the years as a result of efforts to find the most effective product with the fewest number of side effects for humans with diabetes mellitus. Veterinarians have had to base their insulin choices on the availability of human insulin products. The original insulins were animal based, but technologic advances, along with the goal of avoiding antiinsulin antibody production in humans, led to the development of human recombinant insulins. The recent advent of insulin analogues has shifted human insulin market demands, and veterinarians have been forced to follow suit. This article is a guide to the insulin products available for veterinary use. Diabetes mellitus (DM) is one of the most common endocrinopathies diagnosed in dogs and cats. It results from absolute or relative insulin deficiency secondary to impaired insulin secretion by the beta cells. The three main goals of treatment of DM are: To reduce the clinical signs (polyuria, polydipsia, polyphagia) associated with the disorder To achieve glycemic control without inducing hypoglycemia To reduce the development of long-term complications (cataracts and diabetic neuropathies) Insulin therapy is the mainstay of treatment of DM in dogs and cats because it offers the most reliable means of achieving glycemic control. Insulin lowers blood glucose levels by stimulating peripheral glucose uptake and inhibiting hepatic glucose production. Insulin also inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis.1 Insulin inhibits the progression of beta cell destruction by reducing glucose toxicity to the cells.2 In cats, insulin appears toprevent formation of amyloid deposits derived from islet amyloid polypeptide.3 Therefore, it is clear that insulin is the mos Continue reading >>
Manufacturer: Merck Animal Health PORCINE INSULIN ZINC INJECTION (Mfr. Std.) STERILE SUSPENSION 40 I.U./ML FOR VETERINARY USE ONLY DIN 02052474 Description Caninsulin is an intermediate-acting insulin. Each ml of Caninsulin contains highly purified porcine insulin 40 IU (Ph. Eur.) consisting of 30% amorphous zinc insulin and 70% crystalline zinc insulin (“Lente” type). Non medicinal ingredients include (per ml): zinc chloride 0.08 mg, sodium acetate trihydrate 1.36 mg, sodium chloride 7.0 mg and methyl parahydroxybenzoate 0.1% (as preservative). pH is adjusted by adding hydrochloric acid and/or sodium hydroxide. Caninsulin Indications Caninsulin is indicated for the control of hyperglycemia associated with diabetes mellitus in dogs and cats. Caninsulin Dosage And Administration The starting dose is calculated based on the dog’s or cat’s body weight as directed in the Tables below. Dose-titration is necessary to meet the treatment needs of each individual animal. After a period of acclimatization, a blood glucose curve should be determined and the dose adjusted to achieve satisfactory long term control (see Monitoring and Dose Adjustment section below). Compare Pharmacy Prices Compare Local Prescription Prices. Get a Free Coupon & Save up to 80% goodrx.com STARTING DOSE: Dogs: The recommended starting dose of Caninsulin is 0.5 I.U. per kg of body weight once daily, rounded down to the lowest entire number of units. Some examples are given in the following table. Dog Body Weight Starting Dose Per Dog 5 kg 2 I.U. once daily 10 kg 5 I.U. once daily 15 kg 7 I.U. once daily 20 kg 10 I.U. once daily STARTING DOSE: Cats: The recommended starting dose is 0.25 - 0.5 I.U. per kg of body weight, for a maximum of 2 I.U. per dose, based on blood glucose concentration at diagn Continue reading >>
Storing Insulin And Prefilling Syringes - Topic Overview
Insulin can become damaged and ineffective if it is not stored properly. Unopened insulin that is packaged in small glass bottles (vials) should be stored in the refrigerator. Liquid insulin that is packaged in small cartridges (containing several doses) is more stable. It may be kept unrefrigerated, but it will last longer if it is kept in the refrigerator. These cartridges are used in pen-shaped devices (insulin pens) with attached disposable needles. Powdered insulin cartridges are packaged in blocks of three on cards sealed in foil. Keep unopened foil packages in the refrigerator. After you open a foil package, use the contents within 10 days. And after you tear off and open a block of three, discard any unused insulin after 3 days. Always read the insulin package information that tells the best way to store your insulin. You can keep open bottles with you if you keep them in a dark place. The bottles should not be exposed to temperatures below 36°F (2.2°C) or above 86°F (30°C). Never leave insulin in the sun or in your hot car, because sunlight and heat reduces the strength of the insulin. Avoid shaking insulin bottles and liquid insulin cartridges too much to prevent loss of medicine strength and to prevent clumping, frosting, or particles settling out. Follow the storage information provided by the manufacturer. The first time you use an insulin bottle, write the date on the bottle label. Always store an extra bottle of each type of your insulin in the refrigerator. If you cannot prepare an insulin dose but can give the injection, you may need someone to prepare your insulin dose for you. A family member, friend, or health professional can prefill insulin syringes for you. If you prefill syringes: Store prefilled syringes in the refrigerator with the needle p Continue reading >>
Caninsulin Fade-away Effect / Storage Temp
Noah can slip into "high-dose/bouncer" mode if you look at him wrong. He's usually a tiny bit higher than I'd like but there's no in-between with him. I'm okay with all this, he eats despite his horrible teeth, his pain is managed, lots of stuff. Today I opened a new vial and I'll be hovering over him because that's how Caninsulin seems to work, it very slowly fades away. Does this happen to anyone else? Should I be starting a new vial every 14 days? No 2 fridges are the same and even if I kept a thermometer in there I can't control the temp that closely. I use the butter box. I just looked at 2 FAQs that were of no help! Why does Caninsulin seem to fade away? "The product should be used for 21 days, 28 days or 42 days after first opening, depending on the country. Considering I don't have a medical grade fridge what temperature blah blah.... Wow, thanks Doctor Of-No-Help-Whatsoever! Depending on the country??? I'm glad I'm not on Twitter because this little snippet was included. No, Vetsulin/Caninsulin are manufactured by Merck Animal Health in Germany. Sorry Donald, I'm doing the best I can. Is Puerto Rico an island? Where does everyone else keep their insulin? Oh gosh I think I'm right there with you. I've heard so many people use until the vial was empty, or get months of use out of it, but I find we still need to get a new vial after a month... maybe a month and a half if we're really lucky. Originally, we were keeping ours in the butter box (in the fridge door), but then we thought maybe that wasn't keeping the temp consistent enough. So now we have it in the wine bottle holder in the middle of the fridge (it keeps it up out of the way so it doesn't get lost within the fridge). I've wondered if it was starting to fade again, but I never actually know. I feel like Continue reading >>
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Can Insulin Vials Be Kept Safely Outside The Refrigerator?
Q. I am on a website where information is exchanged between people with type 1 diabetes. Half the people say that insulin doesn’t need refrigeration after it is opened and half say that it still needs refrigeration. After having diabetes for 42 years, I have never heard that keeping insulin at room temperature is okay. Is it? Doesn’t temperature affect how well the insulin works? A. The American Diabetes Association recommends that a bottle of insulin can be stored at room temperature (59 to 86 degrees F) for up to one month after it is opened. Storing it in the refrigerator after opening does not make it last longer. Unopened insulin can be stored at room temperature for one month or in the refrigerator (not in the freezer!) until it reaches its expiration date. Insulin must be protected from extremes of heat or cold, which means not leaving it in the glove box or trunk of the car during the summer. Mail order delivery can pose problems. One reader had a delivery of insulin sit outside for hours in the winter. The pharmacy told her it should be fine, but it did not control her blood sugar properly. If you get your insulin by mail order, check with the pharmacy to verify that it will not sit in a hot delivery truck or mailbox in warm weather. Continue reading >>
Everything You Ever Wanted To Know About Injecting Insulin…
But Didn’t Know to Ask Just take your shot. What could be easier, right? Well, you’d be surprised how many errors are made by “veteran” insulin users. It turns out there’s nothing basic about the basics of insulin injections. However, you can improve your technique. This article takes a look at the nitty-gritty details behind successful insulin delivery, why they matter, and how to avoid common pitfalls. The gear Realistically, there are two delivery systems when it comes to injecting insulin: syringes and pens. Yes, there are pumps, but that’s a whole other subject. And yes, there are jet injectors, but they are not widely used. Syringes. The first-ever human insulin shot was delivered by syringe in 1922, and here in the United States, more than half of all insulin is still delivered via syringe. Syringes used to be made of glass, had to be sterilized between uses, and had long, thick, steel surgical needles that could be resharpened on a kitchen whetstone. (No kidding.) But syringes have come a long way since then. Syringes are now disposable, the barrels are made of plastic, and the needles are thin, high-tech, multi-beveled, and coated with lubricants to make them enter the skin smoothly. (Bevels are the slanted surfaces on a needle that create a sharp point.) In the old days, the needle and the syringe were separate components. Nowadays most insulin syringes come with the needle attached. People who use syringes almost always purchase insulin in vials. Vials are glass bottles that generally hold 1,000 units of insulin. Pens. Insulin pens date from the mid-1980s, and while syringes still predominate in the United States, much of the rest of the world has traded in syringes for insulin pens. Pens currently come in two varieties: disposable, prefilled pens Continue reading >>
Must Insulin Be Stored In The Refrigerator?
I have a newly diagnosed diabetic dog on NPH insulin, whose owner has not been refrigerating the insulin (Novolin N). I instructed him to store the open insulin vial in the refrigerator. However, the pharmacy where he purchased the insulin put a sticker on the vial that says it can be left at room temperature. The owner also claims he looked it up online and says it doesn't have to be refrigerated. I have always been taught that insulin must remain in the refrigerator or it loses it's "potency." I did look up the FDA Patient Package Insert online, which says the following: All Unopened Novolin N: Keep all unopened Novolin N in the refrigerator between 36° to 46°F (2° to 8°C). Do not freeze. Do not use Novolin N if it has been frozen. If refrigeration is not possible, the unopened vial may be kept at room temperature for up to 6 weeks (42 days), as long as it is kept at or below 77°F (25°C). Keep unopened Novolin N in the carton to protect from light. Opened Novolin N Vials: Keep at room temperature below 77°F (25°C) for up to 6 weeks (42 days). Keep vials away from direct heat or light. Throw away an opened vial after 6 weeks (42 days) of use, even if there is insulin left in the vial. Unopened vials can be used until the expiration date on the Novolin N label, if the medicine has been stored in a refrigerator. So, is it okay for this man to leave the opened insulin at room temperature? This owner has been doing so for several weeks now but we still haven't gotten the dog regulated! My Response: Yes, it is fine to leave an opened NPH insulin vial at room temperature, but if left out of the refrigerator, we should discard it after 6 weeks (1-3). In extremely hot climates, it has been recommended that the vial be replaced even more frequently if left unrefrigerate Continue reading >>
Question Re Unopended Insulin That Has Reached Room Temp And Then Put Back In Fridge
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Question re unopended Insulin that has reached room temp and then put back in fridge I am a Type 1 diabetic on a pump and have a question about insulin storage. If unopened insulin reaches room temperature (Novorapid Aspart) can it be put back into the fridge and stored without it breaking down and losing it's potency for the shelf life of the vial/cartridge? In other words, does reaching room temperature impact on the potency and shelf life of the then re-refrigerated, unopened insulin? I've checked online and the insulin package information and there is no clear answer to this question. The reason I ask is I travel a lot and need to take large amounts of insulin with me. I put into a cool bag or wrap it silver foil, but after a long journey and customs now-a-days forcing all liquids to be x-rayed out of their boxes and cool bags I'm pretty certain the insulin is reaching room temperature while travelling. Further, I've noticed that my pharmacy sometimes delivers my insulin in a paper bag and it is not always cold... I'm last on their delivery route. I get a 3 month supply minimum due to my work lifestyle. As I've also been struggling to keep my blood sugars below 15... I'm regularly 12-22 for 4-5 hours after eating and I've checked my insulin/carb ratio, site rotation, correct catheter insertion, bleeding at catheter site, stress levels, etc, but even though I'm doing all this right it's like my insulin sometimes stops working and I've often have to double dose to get an affect... which of course puts me at risk of a hypo. In fact, sometimes I have almost no impact on my blood glucose levels despite taking double... I just can't work it out! Other t Continue reading >>
Information Regarding Insulin Storage And Switching Between Products In An Emergency
en Español Insulin Storage and Effectiveness Insulin for Injection Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. According to the product labels from all three U.S. insulin manufacturers, it is recommended that insulin be stored in a refrigerator at approximately 36°F to 46°F. Unopened and stored in this manner, these products maintain potency until the expiration date on the package. Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work. However, an insulin product that has been altered for the purpose of dilution or by removal from the manufacturer’s original vial should be discarded within two weeks. Note: Insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes. This can result in loss of blood glucose control over time. Under emergency conditions, you might still need to use insulin that has been stored above 86°F. You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin. Do not use insulin that has been frozen. Keep insulin away from direct heat and out of direct sunlight. When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. If patients or healthcare providers have specific questions about the suitability of their insulin, they may call the respective manufacturer a Continue reading >>
Insulin Pens Are Welcome Back To The Fridge!
We all know that unopened insulin must be kept in the refrigerator. But once in use can we put it back in the fridge to protect it from excessive heat? The answer to this simple question is not as easy as one might think. All manufacturers explicitly recommend to ‘Not refrigerate’ insulin pens in use. This guideline that causes confusion among users is now being revoked by one manufacturer. Let’s try to understand the reasoning behind it and what it means for users now. What? I shouldn’t put my insulin pen back in the refrigerator? When it comes to storing medications, it is recommended you follow the leaflet or packaging instructions. For insulin in particular, there are two different situations: storing and in-use. · Before Opening: When insulin is to be stored long-term and has not been opened, keeping it in the fridge ensures it lasts until expiration date. · During Use: Once a vial, a cartridge or a new disposable pen are used for the first time, the insulin can be kept at room temperature. But it needs to be used within weeks. It makes sense: higher temperatures and an open product mean a shorter shelf life. But there is one extra sentence on insulin pens packages, which has caused quite some confusion: Pens in use — ‘Do not refrigerate.’ What does ‘do not refrigerate’ mean for users? Let’s take a trip back to 2003, when the recommendation to not refrigerate opened insulin first appeared. Take Lilly’s Humalog for example, for which the label was first altered 14-years ago: What was the reason behind this? People started to speculate this warning was a result of preventing any kind of temperature extremes from affecting the insulin once it is in use. Many insulin users know from experience that high temperature can lower the effectiveness of Continue reading >>
Novolog® Mix 70/30 Storage
Home or Away, NovoLog® Mix 70/30 Goes With You NovoLog® lasts up to 14 days without refrigeration after first use, so it can be taken almost anywhere. Once in use, NovoLog® Mix 70/30 FlexPen® must be kept at room temperature below 86°F for up to 14 days. Here is a quick guide to NovoLog® Mix 70/30 storage: Not in use (unopened) Room temperature: below 86°F Not in use (unopened) Refrigerated In use (opened) Room temperature: below 86°F 10-mL vial 28 days Until expiration date 28 days (can be kept refrigerated or at room temperature) 3-mL NovoLog® Mix 70/30 FlexPen® 14 days Until expiration date 14 days (do not refrigerate) Do’s: Don’ts: Do store unused NovoLog® Mix 70/30 in a refrigerator between 36° to 46°F (2° and 8°C) Don't store NovoLog® Mix 70/30 in the freezer or directly adjacent to the refrigerator cooling element Don't freeze NovoLog® Mix 70/30 or use NovoLog® Mix 70/30 if it has been frozen Don't draw NovoLog® Mix 70/30 into a syringe and store for later use Do keep vials at temperatures below 86°F (30°C) for up to 28 days after initial use. Opened vials may be refrigerated Do use unpunctured vials until the expiration date printed on the label if they are stored in a refrigerator Do keep unused vials in the carton so they will stay clean and protected from light Don't expose vials to excessive heat or light Do keep NovoLog® Mix 70/30 FlexPen® at room temperatures below 86°F (30°C) for up to 14 days once it is punctured Don't store in use NovoLog® Mix 70/30 FlexPen® in the refrigerator Do keep NovoLog® Mix 70/30 FlexPen® away from direct heat and sunlight Don't expose NovoLog® Mix 70/30 FlexPen® to excessive heat or sunlight Do use unpunctured NovoLog® Mix 70/30 FlexPen® until the expiration date printed on the label if they Continue reading >>
How Long Can Insulin Stay Out Of Fridge Temps.
How long can insulin stay out of fridge temps. Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. How long can insulin stay out of fridge temps. How long is it ok to keep insulin at normal room temperatures and maybe warmer for? I'm concerned about my 8 hour flight next week to NY. My 4 months insulin suply will be with me in my hand-lugage for whole 2 days before i will be able to refrigerate it. I don't usually keep my pens in the fridge at all, just the insulin I haven't opened, my pens are usually ok for a week. I'm just concerned about my hwole 4 months suply getting too warm Laura Lu, Your insulin should fare just fine for your eight hour flight. Keeping it in your hand luggage is smart. The planes are kept at a comfortable temp for insulin. Refrigerate it when you arrive and you will be just fine. If you feel so inclined you can get freezer packs, but you will have to do some fancy explaining at the gate. Usually, you can get your packs through the inspection if you have adequate reason. KGM managed to get her freezer packs through hand luggage inspection by claiming she needed to keep her insulin cool. All they can do is make you throw it out. Yea,for 8 hours insuline is ok....!!!but be careful,if insuline dosen't work buy new package of insuline... My insulin was fine when I flew from NY to Ireland a few years ago. I had to keep it in my luggage in a hostel for a WEEK before i finally found a flat and could use the refrigerator. I was a little nervous about the whole 6 month supply going bad, but it was fine. This was, however, in Ireland in winter. During those 2 days will you be in airports / airplanes and hotels that have a/c for Continue reading >>
Caninsulin is an intermediate-acting insulin. Each mL contains highly purified porcine insulin 40 IU (Ph. Eur.) consisting of 35% amorphous zinc insulin and 65% crystalline zinc insulin (Lente type). Non medicinal ingredients: (per mL): zinc chloride 0.08mg, sodium acetate trihydrate 1.36 mg, sodium chloride 7.0 mg and methyl parahydroxybenzoate 0.1% (as preservative). ADMINISTRATION:With vials, the use of U-40 insulin syringes is strongly recommended to ensure accurate dosing. Shakethe vialthoroughly until a homogeneous, uniformly milky suspension is obtained. Foam on the surface of the suspension formed during shaking should be allowed to disperse. In case the suspended particles have settled during the waiting period, the product should be mixed again, gently this time, prior to use, to maintain a homogeneous, uniformly milky suspension. Turnthe cartridgeup and down at least 10 times until the insulin appears uniformly milky. Do not use if clumps, particles, or flocculation are visible after mixing. The contents should be used within 6 weeks (vials) or 28 days (cartridges) and stored below 25C after the first dose is removed. Inject subcutaneously 2 to 5 cm from the dorsal midline on alternating sides, varying from behind the scapula to the mid-lumbar region. *** Please Note: This product will be packed on ice and shipped out using express shipping only. Refrigerated products may not arrive cold, however please note that this product is able to withstand room temperature for up to 72 hours. Continue reading >>
Update On Insulin Treatment For Dogs And Cats: Insulin Dosing Pens And More
Authors Thompson A, Lathan P, Fleeman L Accepted for publication 19 February 2015 Checked for plagiarism Yes Peer reviewer comments 3 1School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia; 2College of Veterinary Medicine Mississippi State University, Starkville, MS, USA; 3Animal Diabetes Australia, Melbourne, VIC, Australia Abstract: Insulin therapy is still the primary therapy for all diabetic dogs and cats. Several insulin options are available for each species, including veterinary registered products and human insulin preparations. The insulin chosen depends on the individual patient's requirements. Intermediate-acting insulin is usually the first choice for dogs, and longer-acting insulin is the first choice for cats. Once the insulin type is chosen, the best method of insulin administration should be considered. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Pens have different handling requirements when compared with standard insulin vials including: storage out of the refrigerator for some insulin preparations once pen cartridges are in use; priming of the pen to ensure a full dose of insulin is administered; and holding the pen device in place for several seconds during the injection. Many different types of pen devices are available, with features such as half-unit dosing, large dials for visually impaired people, and memory that can display the last time and dose of insulin administered. Insulin pens come in both reusable and disposable options. Pens have several benefits over syringes, including improved dose accuracy, especially for low insulin doses. Keywords: diabetes, mellitus, canine, feline, NPH, glargine, porcine lente Introduction Insulin the Continue reading >>
Can Insulin Go Back In The Fridge?
After removing insulin glargine (Lantus) from the refrigerator for use, can it be refrigerated over and over again after having warmed to room temperature, or does this degrade it? Continue reading >>