What is Caninsulin?

Caninsulin is a porcine insulin zinc suspension, provided by MSD Animal Health in the U.K. and is available in 10 ml and 2.5 ml vials for injection and 2.7 ml cartridges for use in VetPen^®.

Is Caninsulin new?

No – Caninsulin is registered in over 30 countries. First registered in Australia in 1990, the established safety and efficacy profile of Cainsulin is supported by more than 25 years experience.

Does Caninsulin have to stay refrigerated?

Unopened Caninsulin vials and cartridges should be refrigerated (between+2 and +8°C). Once opened, broached Caninsulin vials and cartridges can be stored at up to 25°C. Caninsulin preparations should always be protected from light and never frozen.

Important Note: This revised storage guidance is specific for UK vials with a blue top and cartridges with a silver top which contain metacresol as the preservative.

What type of insulin is Caninsulin?

Caninsulin is an intermediate-acting, lente insulin containing 40 IU per ml of highly purified porcine insulin. As a lente insulin, Caninsulin consists of 35% amorphous Zinc insulin and 65 % crystalline Zinc insulin in a suspension.

Can Caninsulin be diluted?

No – Caninsulin is a stable, balanced 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. If Caninsulin is diluted, the balance between amorphous and crystalline parts is no longer 30% and 70%, relatively speaking, and the amount of soluble insulin is increased by the aqueous diluent used. This results in an alteration of the pharmacokinetics of Caninsulin. With a larger aqueous fraction, there would be a relative decrease in the crystalline portion, which is responsible for the second peak of insulin activity. This would mean that diabetic patients receiving Caninsulin could become unstable.

In addition, if Caninsulin is diluted, the stability and sterility of the suspension cannot be guaranteed.

How does Caninsulin differ from human insulin products?

The porcine insulin in Caninsulin has the same amino acid sequence as natural canine insulin, whereas that of biosynthetic human insulins is different³. The similar structure of porcine insulin may provide more effective regulation of blood glucose and decrease the risk of anti-insulin antibody development in dogs. Unlike the dog, anti-insulin antibodies do not appear to be a clinically relevant problem in cats.

How long can Caninsulin be used once opened?

Caninsulin vials and cartridges should be discarded 42 days after they are first broached.

Important Note:This revised broached vial shelf life advice is specific for UK vials with a blue top and cartridges with a silver top which contain metacresol as preservative

How many IU are there per bottle or cartridge?

2.5 ml glass vials: 2.5 ml x 40 IU/ml = 100 IU

10 ml glass vials:

10 ml x 40 IU/ml = 400 IU

2.7 ml cartridge:

2.7 ml x 40 IU/ml = 108 IU

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 disease progression (e.g. alterations in the sensitivity of issue receptors) or factors such as stress and weight gain (which may increase insulin resistance, especially in cats) and changes in exercise patterns.

One of the key reasons for a perceived reduction in stability may be the development of concurrent diseases such as pancreatitis, pancreatic neoplasia or exocrine pancreatic insufficiency (EPI). On top of this some hormone conditions can affect the efficacy of insulin:

In dogs:

Endogenous or exogenous hormones may reduce the effects of insulin. Medication with progestogens should be discontinued immediately and entire bitches should be spayed.

If animals are being treated with exogenous corticosteroids, alternatives to this treatment should be sought or the dose minimised.

Cushing’s disease (hyperadrenocorticism) leads to an increase in the endogenous production of corticosteroids and has many clinical signs in common with diabetes. Where dogs are not responding as expected to their insulin dose, an ACTH stimulation test should be performed to rule out or help diagnose this condition.

In cats:

Acromegaly, caused by a growth hormone–secreting tumour of the anterior pituitary, may be a secondary factor in cases of uncontrolled diabetes mellitus and this condition should be ruled out during the initial diagnostic work-up.

If crystallisation 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 crystallisation 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 MSD Animal Health account manager.

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 re-suspended the product, do not use it.

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

Is there any information about the use of Caninsulin in rabbits?

Caninsulin is not licensed for rabbits. For more information on diabetes in rabbits, you can call MSD Animal Health Technical Product Support on 01908 685685.

How does Caninsulin work in dogs?

A lente (intermediate-acting) form of insulin, Caninsulin contains 30% amorphous insulin for rapid onset of activity, usually peaking 4 hours after injection and lasting 8 hours. The remaining 70% of the formula is crystalline insulin which is absorbed more slowly and peaks around 11 hours after administration. The Caninsulin formula allows for a more continuous utilisation of glucose to support the body’s basic functions. Caninsulin should be administered subcutaneously once or twice daily, as required.  Two-thirds of dogs require twice-daily administration for effective glycaemic control^4,5.  

How does Caninsulin specifically benefit canine patients?

Caninsulin is the first U.K. veterinary licensed insulin for the management of diabetes in dogs which allows once or twice daily dosing for maximum flexibility. Other benefits include:^11,12,13

• Rapid glycaemic control – the amorphous fraction activity peaks at around 4 hours post-injection and lasts for 8 hours
• Sustained effect – the crystalline fraction is absorbed slowly, with effects peaking at about 11 hours post-injection
• A duration of action from 14 to 24 hours
• Minimal risk of anti-insulin antibodies – the porcine insulin in Caninsulin is identical to natural canine insulin
• VetPen can be used for simple and accurate dosing

How often does Caninsulin need to be administered to dogs?

In dogs, the initial recommended Caninsulin dose is 0.5 to 1.0 IU/kg, given once or twice daily as appropriate, following assessment via a blood glucose curve. The first dose should be given at the same time as food, or immediately after eating.

Vets should re-evaluate at appropriate intervals and adjust the dose in 10% increments based on clinical signs and glucose curve values until adequate glycaemic control has been attained. Dose changes should not be made more frequently than once every 3 days (ideally after 7 days).

Twice-daily therapy should be initiated if the duration of action of insulin once daily is determined to be inadequate.

If twice-daily treatment is initiated, each of the two doses should be 25% less than the once-daily dose required to attain an acceptable nadir.

The impact on blood glucose peaks may last from 14 to 24 hours, and approximately one-third of dogs with diabetes can achieve successful diabetes management with a single dose of Caninsulin per day⁵.

Can Caninsulin really be used only once daily in dogs?

Clinical studies have demonstrated that approximately one-third of dogs can be maintained adequately on once-daily doses of Caninsulin. The other two-thirds of dogs will require twice-daily administration of Caninsulin^4,5.

How many dogs currently have diabetes?

It is estimated that the incidence of diabetes in dogs is up to 1 in 300^6,7.

How does Caninsulin work in cats?

Caninsulin is a lente (intermediate-acting) form of insulin that contains 30% amorphous insulin for rapid onset of activity. In cats, the peak activity following subcutaneous administration of Caninsulin occurs between 4-6 hours (with an average of about 4 hours) and the duration of activity varies between 8 and 12 hours⁸. Therefore, in cats, Caninsulin is initially administered twice daily rather than once daily.

How Does Caninsulin specifically benefit feline patients?

Caninsulin offers a predictable onset and constant duration of effect in cats.

• Peak activity occurs between 4-6 hours (average of 4 hours) post injection
• Flexible, easy dosing via vials or VetPen

How often does Caninsulin need to be administered to cats?

In cats, the initial recommended dose is 1 or 2 IU per injection given twice daily. So, unlike dogs where initial dosing is based on the baseline blood glucose concentration, dosing of Caninsulin in the feline is on a per-animal basis. The duration of activity of Caninsulin in the cat is shorter than in the dog, ranging between 8 to 12 hours and peak activity levels occurs between 4-6 (average of about 4) hours⁸.

How many cats currently have diabetes?

It is estimated that the incidence of diabetes mellitus in cats is 1 in 200^9,10.

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

The use of traditional injection techniques via a syringe and needle may be a problematic in this case, as the re-suspension of insulin in such small doses and the effect of prolonged contact with syringe materials is unknown.

Alternatively, the use of VetPen for owners that may experience difficulties, may be a good solution. Once the device is primed (which can be done by anyone), VetPen can be stored at up to 25°C and used daily until a replacement cartridge is needed. VetPen delivers an accurate and consistent dose and is easy to use, removing much of the worry for elderly owners, or those with dexterity issues.