Tuesday, October 7, 2014

National Pet Obesity Awareness Day

On Wednesday, October 8, 2014, the Association for Pet Obesity Prevention (APOP) will conduct its Eighth Annual Pet Obesity Awareness Day survey in an effort to more accurately determine the exact number of pets in the United States that are overweight or obese. Pet owners and veterinarians are encouraged to participate in the study.

Please visit the APOP website to learn more, as well as to participate in this important study.

Association for Pet Obesity Prevention website. www.petobesityprevention.org

Thursday, September 18, 2014

Your Thyroid: What You Need to Know

I came across this information sheet about "Your Thyroid," which came from the Hormone Health Network.  Although very simplistic, this still makes it clear that the thyroid gland and it's thyroid hormone secretion is very important for overall body function.  It also helps clarify the regulatory feedback system between the pituitary gland (secreting TSH) and the thyroid gland (secreting T4 and T3).  

For more information and fact sheets about specific thyroid diseases, click here. To learn more about other endocrine glands and their diseases, visit the Hormone Health Network website at http://www.hormone.org.

Tuesday, September 9, 2014

Dr. Peterson Interviewed in the Journal of Feline Medicine and Surgery

Dr. Peterson was interviewed for the September issue of the Journal of Feline Medicine and Surgery.

The interview provides some interesting insights into Dr. Peterson's career, his own cats, and his aspirations and goals as he continues his research.

Click here to download and read the full interview.

Tuesday, July 22, 2014

Dr. Peterson Interviewed for Dog Fancy Article About Insulin Pen for Dogs

Dr. Peterson was interviewed for the September 2014 issue of Dog Fancy (pictured above). Merck Animal Health has just received approval from the FDA to sell their VetPen product, the first insulin injection pen available for diabetic dogs and cats, and Dr. Peterson weighed in on the benefits of such an easy-to-use device.

Monday, May 26, 2014

Celebrate the Seventh Annual World Thyroid Day

It's not just cats and dogs that develop thyroid disease. Approximately 750 million people worldwide are affected by thyroid disorders, and the Seventh Annual World Thyroid Day, being held this weekend, has 5 major goals, say the organizations who support it. These include the American Thyroid Association (ATA), the European Thyroid Association, the Asia Oceania Thyroid Association, and the Latin American Thyroid Society.

The thyroid gland produces hormones that regulate the body's metabolism and influence every cell, tissue, and organ in the body, they point out. Hypothyroidism is characterized by symptoms of fatigue, depression, and forgetfulness, while hyperthyroidism is associated with irritability, nervousness, and muscle weakness.

The aims of World Thyroid Day are the following:
  • Increase awareness of thyroid health. 
  • Promote understanding of advances made in treating thyroid diseases. 
  • Emphasize the prevalence of thyroid diseases. 
  • Focus on the urgent need for education and prevention programs.
  • Expand awareness of new treatment modalities.
The thyroid gland, butterfly-shaped and located in the middle of the lower neck, produces hormones that influence every cell, tissue and organ in the body. The thyroid hormones regulate the body's metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects critical body functions, such as energy level and heart rate.

The thyroid also plays a critical role during pregnancy, the thyroid societies explain. Consequently, the ATA recommends that pregnant women at high risk for thyroid disease should have their thyroid function tested early in their pregnancy. Another important issue is thyroid cancer, which is rapidly increasing, according to the ATA, which says there were 44,670 new cases of thyroid cancer recorded in 2010 in the United States.

But when thyroid cancer is identified and treated early, "the majority of patients can be completely cured," the American Thyroid Association stresses. The organization also notes that it is important to distinguish thyroid cancer from benign thyroid nodules, which are common in the population.

Patient education on human thyroid conditions can be found on the ATA website at http://www.thyroid.org/patient-thyroid-information/.

Thursday, May 22, 2014

Insect Repellent, Antiviral Drug Detected in Jerky Pet Treats for Dogs

Chicken jerky treats consumed by dogs that became sick over the past few month have now been found to be tainted by the insect repellent N,N-diethyl-meta-toluamide, better known as DEET, as well as the antiviral drug amantadine.

This is according to a veterinary pathologist leading an independent probe of the ongoing pet treat mystery.  For more information, click this link to read the article by the Veterinary Information Network News Service.

Friday, April 4, 2014

Insulin Injection Pen (VetPen): More Questions (and Answers) about this New Diabetic Product

Since the FDA approved the use of a new insulin injection pen (VetPen) made by Merck Animal Health last week (1,2), I've received a number of questions from both veterinarians and owners of diabetic pets. Listed below are some of the most common questions with my responses.

Do we buy a single VetPen and use it forever? Or does the VetPen have to be replaced after a month or two?

The VetPen has been tested for at least 3,000 actuations (i.e., how many times the insulin release button is pressed and released). Therefore, a single VetPen is likely to last a lifetime for the majority of dogs and cats treated with diabetes.

How are the pens and cartridges sold? 
The reusable VetPen is supplied in a Starter Kit which contains everything you need to get started (see below). This included everything except the Vetsulin cartridges, which are supplied separately in cartons of ten, 2.7-mL cartridges.

The VetPen itself is available in 2 sizes. For greater accuracy at low doses, the first option (blue cap) has a maximum total dose of 8 units, allowing for dosing increments of 0.5 unit per injection. If higher insulin doses are being administered, the second VetPen option (tan cap) has a maximum total dose of 16 IU per injection, with dosing increments of 1 unit.

What is in each VetPen Starter Kit?
Each Starter Kit contains either an 8-unit or 16-unit VetPen with an instruction leaflet.

The kit also contains a box of 28-g, ultra-thin needles that feature a silicone coating to help minimize injection discomfort, as well as a needle remover that helps to remove used needles, while minimizing the risk of accidental needle stick injury. There is also a travel pouch to hold all of the components.

The kit also contains two adaptors to assist those with dexterity issues. The dose selector adaptor may be used to provide a better grip when selecting a dose. The release button extension may be used to provide a better grip when giving injections.

Are the VetPens an accurate way for insulin dosing?
The VetPen is ideal for cats and small dogs on low doses of insulin, in which dosing accuracy can be a concern (3,4). A recent study comparing the precision and accuracy of the VetPen to U40 syringes demonstrated that even when doses were drawn up by trained laboratory technicians, syringes were found to deliver at least 20% to 25% more insulin than needed for a 1-unit dose (5).

In contrast, VetPen enables doses to be delivered with accuracy and precision down to 0.5 units. In large dogs, dosing accuracy is generally not a problem.

Do the pens and cartridge need to be refrigerated? Other handling precautions?
The VetPen cartridges should be refrigerated (not frozen) and protected from light before opening.

VetPen does not need to be refrigerated after a cartridge has been started (4), although it probably is best to do so. The loaded VetPen can be stored on its side in the refrigerator.

VetPen should always be stored or carried with the needle removed and the cap on. To clean the device, wipe with a damp cloth. Do not immerse in water.

Are the VetPens expensive? How would the costs of the VetPen compare to those associated with the standard insulin vial/syringe method?

The cost of treatment will depend upon the size of the diabetic pet. For smaller dogs and cats, the price of the VetPen with the Vetsulin cartridges and needles will be similar to the cost of the standard 10-mL Vetsulin vial and U-40 insulin syringes.   For larger dogs, the standard way of administering Vetsulin (via an insulin syringe) would generally be a more economical way to provide insulin treatment.

Bottom Line:

These insulin pen devices are an alternative to the traditional insulin vial-and-syringe method and offer many advantages. In human diabetic patients, insulin pens have also been found to be less painful than the vial-and-syringe method and are often associated with greater patient preference and social acceptability (6-11).  Similar preliminary findings have been documented in dogs and cats (12,13). As a result, this method of insulin delivery may ultimately help to improve glycemic control and should be considered as an alternative insulin delivery method.

Insulin pens are designed to deliver a fixed insulin dose while insulin syringes rely on the ability of the user to accurately draw up the required insulin dose. One recent study reported that for low doses (below 8 units), the VetPens were more precise and accurate than the insulin syringes (5). In particular, insulin syringes tend to over-deliver, compared to the insulin pen, for very low doses (1 unit). For higher doses (16 units), both devices were comparable (5).

Similar findings have been reported in human pediatric patients, in which very low doses of insulin must be administered. One older study looked at the reliability of using U100 syringes for accurately administering low doses of insulin in the hospital by pediatric nurses. In that study, attempts to administer doses of 0.5 U or 1.0 U of U-100 insulin resulted in overdosage of 95% and 66%, respectively (14). Based on this study, it's no wonder that small diabetic dogs or cats are often a challenge to regulate when small insulin doses are needed.

  1. FDA website. FDA Approves First Insulin Product for Use with Automatic Injection Pen in Cats and Dogs.
  2. Press release. Merck Animal Health Receives FDA Approval of VetPen  
  3. Merck Caninsulin website. Caninsulin® VetPen® helps make pet diabetes management easier 
  4. Pet Diabetes website. What you need to know about the Caninsulin VetPen
  5. Burgaud S, Riant S, Piau N. Comparative laboratory evaluation of dose delivery using a veterinary insulin pen. Proceedings World Congress ASAVA/FECAVA/BSAVA 2012;567.
  6. Molife C, Lee LJ, Shi L, et al. Assessment of patient-reported outcomes of insulin pen devices versus conventional vial and syringe. Diabetes Technol Ther 2009;11:529-538. 
  7. Pearson TL. Practical aspects of insulin pen devices. J Diabetes Sci Technol 2010;4:522-531. 
  8. Wright BM, Bellone JM, McCoy EK. A review of insulin pen devices and use in the elderly diabetic population. Clin Med Insights Endocrinol Diabetes 2010;3:53-63. 
  9. Cuddihy RM, Borgman SK. Considerations for diabetes: treatment with insulin pen devices. Am J Ther 2013;20:694-702. 
  10. Davis EM, Foral PA, Dull RB, et al. Review of insulin therapy and pen use in hospitalized patients. Hosp Pharm 2013;48:396-405. 
  11. McCoy EK, Wright BM. A review of insulin pen devices. Postgrad Med 2010;122:81-88. 
  12. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic cats. Proceedings World Congress ASAVA/FECAVA/BSAVA 2012;499.
  13. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic dogs. Proceedings World Congress ASAVA/FECAVA/BSAVA 2012;568.
  14. Casella SJ, Mongilio MK, Plotnick LP, et al. Accuracy and precision of low-dose insulin administration. Pediatrics 1993;91:1155-1157.