Diabetes in Pets
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The only PZI insulin still available for people is [[CP Pharma]]'s [[Hypurin Bovine Protamine Zinc]] and it must be imported from the UK.
 
The only PZI insulin still available for people is [[CP Pharma]]'s [[Hypurin Bovine Protamine Zinc]] and it must be imported from the UK.
   
'''PZI''' veterinary insulins are [[:Category:intermediate-acting|intermediate-acting]] to [[:Category:long-acting|long-acting]], and can be closer in molecular structure to a cat or dog's own insulin than human-type or [[Analog|analog]] insulins. Veterinary PZI is a particularly good insulin type for cats. PZI is rarely used in dogs but is considered when other insulins are not effective<ref>[http://www.royalcanin.us/documents/OSUProceedings.pdf Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Page 40]</ref>.
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'''PZI''' veterinary insulins are [[:Category:intermediate-acting|intermediate-acting]] to [[:Category:long-acting|long-acting]], and can be closer in molecular structure to a cat or dog's own insulin than human-type or [[Analog|analog]] insulins. Veterinary PZI is a particularly good insulin type for cats. PZI is rarely used in dogs but is considered when other insulins are not effective<ref>[http://images3.wikia.nocookie.net/petdiabetes/images/8/87/2006symposiumproceedings.pdf Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Page 40]</ref>.
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NB:Animal-source insulins are becoming harder to make now, and PZIVet's recent discontinuation (see below) is likely the first in a tragic series that will make porcine and bovine-source insulins rare. We can hope that new GM insulins will shortly be introduced to make up the gap.In the meantime the alternatives include these other PZI insulins, and of course the human GM analogs [[Levemir]] and [[Lantus]].
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PZI itself was introduced in 1936; it was the first insulin having any type of [[suspension]]. Before PZI, the only insulin available was [[R]]/[[Neutral]], having no additives to alter or extend its action. Until then, many with diabetes had to get up during the night to take an insulin injection because R/Neutral did not last long enough for an uninterrupted night's sleep<ref>[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=538471&blobtype=pdf Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Journal-1938]</ref> .
 
PZI itself was introduced in 1936; it was the first insulin having any type of [[suspension]]. Before PZI, the only insulin available was [[R]]/[[Neutral]], having no additives to alter or extend its action. Until then, many with diabetes had to get up during the night to take an insulin injection because R/Neutral did not last long enough for an uninterrupted night's sleep<ref>[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=538471&blobtype=pdf Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Journal-1938]</ref> .
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Cats tend to do well on PZI insulins. A 2001 study by Dr. Richard Nelson<ref>[http://avmajournals.avma.org/doi/abs/10.2460/javma.2001.218.38?prevSearch=allfield%3A%28diabetes%29 JAVMA 2001: PZI & Hard to Regulate Cats]</ref><ref>[http://www.antechdiagnostics.com/clients/antechNews/2005/dec05_02.htm Antech Diagnostics Newsletter: Hard to Regulate Cats & PZI]</ref> showed that 75% of previously treated hard-to-regulate cats did well with the insulin. He goes on to saythat most cats do require PZI twice daily. The other 25% of tested cats did not reach [[peak]] with PZI insulin until 9 hours + after injection; they would likely be able to use only one shot per day. As the study illustrates, [[absorption]], [[peak]] and [[duration]] of PZI is variable.
 
Cats tend to do well on PZI insulins. A 2001 study by Dr. Richard Nelson<ref>[http://avmajournals.avma.org/doi/abs/10.2460/javma.2001.218.38?prevSearch=allfield%3A%28diabetes%29 JAVMA 2001: PZI & Hard to Regulate Cats]</ref><ref>[http://www.antechdiagnostics.com/clients/antechNews/2005/dec05_02.htm Antech Diagnostics Newsletter: Hard to Regulate Cats & PZI]</ref> showed that 75% of previously treated hard-to-regulate cats did well with the insulin. He goes on to saythat most cats do require PZI twice daily. The other 25% of tested cats did not reach [[peak]] with PZI insulin until 9 hours + after injection; they would likely be able to use only one shot per day. As the study illustrates, [[absorption]], [[peak]] and [[duration]] of PZI is variable.
   
According to Merck<ref>[http://www.merck.com/mrkshared/mmanual/section2/chapter13/13a.jsp Merck-Excess Protamine Prohibits Same-Syringe Mixing of Protamine Zinc Insulins]</ref>, in cases where a shorter-acting insulin is needed in addition to the PZI, the protamine zinc insulin must always be injected '''separately'''--'''NO mixing'''--due to the excess of [[protamine]] in the insulin formula<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1144249&dopt=Abstract Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975]</ref><ref>[http://www.bnf.org/bnf/bnf/current/4093.htm British National Formulary (BNF)-Protamine Zinc Insulin Binds With Soluble (R/Neutral) in Same Syringe]</ref>.
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According to the UK's National Health Service<ref>[http://images4.wikia.nocookie.net/petdiabetes/images/5/5d/Nhs_uk_diabetes_insulin.pdf NHS UK Excess Protamine Prohibits Same-Syringe Mixing of Protamine Zinc Insulins]</ref>, in cases where a shorter-acting insulin is needed in addition to the PZI, the protamine zinc insulin must always be injected '''separately'''--'''NO mixing'''--due to the excess of [[protamine]] in the insulin formula<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1144249&dopt=Abstract Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975]</ref><ref>[http://images4.wikia.nocookie.net/petdiabetes/images/5/5d/Nhs_uk_diabetes_insulin.pdf NHS UK-Protamine Zinc Insulin Binds With Soluble (R/Neutral) in Same Syringe]</ref><ref>[http://images3.wikia.nocookie.net/petdiabetes/images/9/9d/Petsulin_Protamine_Zinc.pdf Petsulin Protamine Zinc Page 5-Incompatibilities]</ref>.
   
 
==Technical details==
 
==Technical details==
PZI contains more zinc and [[protamine]] than [[NPH]]/[[isophane]] insulin and it is primarily the extra protamine which gives it its [[long-acting]] [[duration]]. The additional [[protamine]] in the [[suspension]]<ref>[http://www.diabetic-help.com/kANIMINS2.txt PZI Insulin--More Protamine Than NPH/Isophane Insulin]</ref> must first be broken down by proteolytic enzymes AKA proteases<ref>[http://en.wikipedia.org/wiki/Proteolytic_enzyme Wikipedia:Proteolytic Enzymes]</ref>, before the insulin in PZI can be absorbed. [[NPH]]/[[isophane]] insulin contains less protamine than PZI does and because there's less, it is an [[intermediate-acting]] insulin.
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PZI contains more zinc and [[protamine]] than [[NPH]]/[[isophane]] insulin and it is primarily the extra protamine which gives it its [[long-acting]] [[duration]]. The additional [[protamine]] in the [[suspension]]<ref>[http://web.archive.org/web/20060613202518/http://diabetic-help.com/kANIMINS2.txt PZI Insulin--More Protamine Than NPH/Isophane Insulin]</ref> must first be broken down by proteolytic enzymes AKA proteases<ref>[http://en.wikipedia.org/wiki/Proteolytic_enzyme Wikipedia:Proteolytic Enzymes]</ref>, before the insulin in PZI can be absorbed. [[NPH]]/[[isophane]] insulin contains less protamine than PZI does and because there's less, it is an [[intermediate-acting]] insulin.
   
 
==No Combining For PZI==
 
==No Combining For PZI==
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Protamine Zinc [[PZI]]<ref>[http://www.merck.com/mrkshared.mmanual/section2/chapter13/13a.jsp Excess Protamine in Protamine Zinc Insulin Formula]</ref> insulin '''cannot''' be combined with other insulins, due to the amount of [[protamine]] in the insulin's formula<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1144249&dopt=Abstract Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975]</ref><ref>[http://www.bnf.org/bnf/bnf/current/4093.htm British National Formulary (BNF)-Protamine Zinc Insulin (PZI) Binds to Soluble Insulin in Same Syringe]</ref>.
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Protamine Zinc [[PZI]]<ref>[http://www.auburn.edu/~deruija/insulin_preparations.pdf Excess Protamine in Protamine Zinc Insulin Formula]</ref> insulin '''cannot''' be combined with other insulins, due to the amount of [[protamine]] in the insulin's formula<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1144249&dopt=Abstract Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975]</ref><ref>[http://images4.wikia.nocookie.net/petdiabetes/images/5/5d/Nhs_uk_diabetes_insulin.pdf NHS UK-Protamine Zinc Insulin (PZI) Binds to Soluble Insulin in Same Syringe]</ref>.
 
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==Specifications of PZI==
 
==Specifications of PZI==
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'''Protamine Zinc Insulin'''
 
'''Protamine Zinc Insulin'''
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Sterile buffered suspension of mammalian insulin to which protamine and zinc chloride are added.
 
Sterile buffered suspension of mammalian insulin to which protamine and zinc chloride are added.
 
White suspension. pH 6.9 - 7.5 iso-osmotic with blood. Contains for each 100 units of insulin, 1 - 1.7 mg of protamine sulphate and zinc chloride equivalent to 200 per g of zinc, 10 - 11 mg of sodium phosphate.
 
White suspension. pH 6.9 - 7.5 iso-osmotic with blood. Contains for each 100 units of insulin, 1 - 1.7 mg of protamine sulphate and zinc chloride equivalent to 200 per g of zinc, 10 - 11 mg of sodium phosphate.
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'''Protamine Zinc Insulin'''
 
'''Protamine Zinc Insulin'''
   
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==Types of Veterinary PZI==
 
==Types of Veterinary PZI==
 
==Manufactured==
 
==Manufactured==
These are manufactured, not compounded, insulins. This means the insulin keeps longer, and is less likely to vary, as compounded insulins can, from batch to batch. The manufactured insulins have a shelf life of three years (unopened).
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These are manufactured, not compounded, insulins. This means the insulin keeps longer, and is less likely to vary, as compounded insulins can, from batch to batch. The manufactured insulins (except ProZinc) have a shelf life of three years (unopened).
   
==PZI Vet (IDEXX)==
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=== ProZinc™===
   
[[Image: 25934-1.jpg|frame|left|PZI Vet by IDEXX-a U40, 90% beef, 10% pork protamine zinc insulin.]] '''[[PZI Vet]]''' is made by [[IDEXX|IDEXX Laboratories]] (formerly Blue Ridge). [[PZI Vet]] is a beef/pork PZI insulin commonly used in diabetic cats in the U.S. Some compounding pharmacies may refer to their PZI insulins as ''PZI Vet,'' but you aren't using PZI Vet<ref>[http://www.idexx.com/animalhealth/pharmaceuticals/pzivet/index.jsp IDEXX Wesbite-PZI Vet]</ref> unless it is made by IDEXX Labs. Unlike the other PZI's below, PZI Vet is a mix of beef and pork insulin. Beef insulin is closest to a cat's own insulin, and pork is identical to a dog's. [[PZI Vet]] is a manufactured insulin; the formula is that of Lilly's 90% beef/ 10% pork Iletin I Protamine Zinc insulin; Blue Ridge purchased it from [[Eli Lilly]] after the firm discontinued it.
 
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==Insuvet PZI==
 
   
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[[File:Prozinc.jpg|thumb|125px|ProZinc™ BIV's U-40 recombinant human insulin]][http://prozinc.us ProZinc™] (protamine zinc recombinant human insulin) is[http://bi-vetmedica.com Boehringer Ingelheim Vetmedica's] replacement for PZI Vet insulin.&nbsp; Boehringer Ingelheim Vetmedica was the purchaser of the PZI Vet franchise from IDEXX.&nbsp; ProZinc is a manufactured (not compounded) U-40 insulin with FDA approval for use in diabetic cats.&nbsp; Dosing is expected to be similar to PZI Vet insulin.&nbsp; According to a BIV technical representative, during efficacy trials cats were switched from PZI Vet insulin to ProZinc in a 1:1 dosing ratio and they did "well."&nbsp; It comes in 10ml bottles and has a shelf life of two years from the date of manufacture.&nbsp; Like other insulins it must be kept refrigerated.&nbsp; Generally ProZinc should be given twice a day.&nbsp; It's characteristics (onset, peak, duration etc.) should approximate if not mirror the old PZI Vet insulin.&nbsp; Since this is a new insulin [Nov 2010] and the supply is on "allocation," supplies may be limited during the immediate future.&nbsp; It is available online, though some vets and some pharmacies.<br /><br />
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=== PZI Vet (IDEXX) ===
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[[Image: 25934-1.jpg|frame|left|PZI Vet by IDEXX-a U40, 90% beef, 10% pork protamine zinc insulin.]]'''[[PZI Vet]]''' was made by [[IDEXX|IDEXX Laboratories]] (formerly Blue Ridge). [[PZI Vet]] is a
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beef/pork PZI insulin commonly used in diabetic cats in the U.S. Some compounding pharmacies may
 
refer to their PZI insulins as ''PZI Vet,'' but you aren't using PZI Vet.<ref>[http://web.archive.org/web/20071209221215/http://www.idexx.com/animalhealth/pharmaceuticals/pzivet/index.jsp IDEXX Website-PZI Vet]</ref> unless it is made by IDEXX Labs. Unlike the other PZI's below, PZI Vet is a mix of beef and pork insulin. Beef insulin is closest to a cat's own insulin, and pork is identical to a dog's. [[PZI Vet]] is a manufactured insulin; the formula is that of Lilly's 90% beef/ 10% pork Iletin I Protamine Zinc insulin; Blue Ridge purchased it from [[Eli Lilly]] after the firm discontinued it.
 
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Note: IDEXX PZI is being '''discontinued''' shortly due to animal insulin supply problems:
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<pre>
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April 8, 2008
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Dear Concerned Cat Owner,
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Recently there have been some developments regarding the availability of PZI VET® (protamine zinc
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insulin), and I wanted to update you on the situation because it may impact your diabetic cat. You
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may know that PZI VET is derived from bovine and porcine pancreatic glands, and unfortunately, the
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supply of our original raw material has been exhausted. As there are no FDA approved facilities for
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harvesting bovine pancreatic tissue, we have determined after extensive study that further
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production of animal source insulins is not practical in a modern manufacturing environment.
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Therefore, following the sale of our existing inventory, IDEXX will no longer manufacture or sell
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any animal-based insulin. We are currently in the process of notifying veterinarians who prescribe
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PZI-VET of the situation. As of April 1, 2008, there was a considerable inventory in distribution,
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so please consult with your own veterinarian on the best course of action for your cat.
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We appreciate that feline diabetes is a chronic condition requiring ongoing treatment and
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monitoring.
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Accordingly, IDEXX remains committed to the treatment of this disease. We are working diligently to
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develop and bring to market a new insulin product for the treatment of diabetes in cats.
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Sincerely,
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Cynthia Cole DVM, PhD, DACVCP
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Manager, Professional Services Group
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IDEXX Pharmaceuticals, Inc.
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</pre>
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=== Insuvet PZI ===
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[[Image:91 main.jpg|thumb| 200 px|right|Insuvet Protamine Zinc--pure beef U100 PZI insulin.]]'''[[Insuvet Protamine Zinc]]''' or '''Insuvet PZI''' is a PZI from [[Insuvet]], similar to BCP's PZI above. Insuvet also makes [[Insuvet|two other veterinary insulins]].
 
[[Image:91 main.jpg|thumb| 200 px|right|Insuvet Protamine Zinc--pure beef U100 PZI insulin.]]'''[[Insuvet Protamine Zinc]]''' or '''Insuvet PZI''' is a PZI from [[Insuvet]], similar to BCP's PZI above. Insuvet also makes [[Insuvet|two other veterinary insulins]].
   
[[Schering-Plough Animal Health]] contracts [[CP Pharma]] to produce its [[Insuvet]] line of [[bovine]] insulins<ref>[http://www.wockhardt.com/part_europe.html SPAH Contracts CP/Wockhardt UK for Insuvet Insulins]</ref>. Some UK pet pharmacies offer both the [[Insuvet]]-branded and the [[CP Pharma|Hypurin]]-branded insulins. The only difference here may be pricing.
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Schering-Plough Animal Health contracted [[CP Pharma]] to produce its [[Insuvet]] line of [[bovine]] insulins<ref>[http://www.wockhardt.com/part_europe.html SPAH Contracts CP/Wockhardt UK for Insuvet Insulins]</ref>. The Insuvet line was sold to [[Pfizer Animal Health]] and it is believed that Pfizer continues to contract CP/Wockhardt UK for their production. Some UK pet pharmacies offer both the [[Insuvet]]-branded and the [[CP Pharma|Hypurin]]-branded insulins. The only difference here may be pricing.
   
 
[[Insuvet]] insulins are only available in the UK; the option for those in other countries is either importing from [[CP Pharma]] or, if you are in North America, the compounded PZI in various strengths available from BCP and VPOA (US) and Summit (Canada).
 
[[Insuvet]] insulins are only available in the UK; the option for those in other countries is either importing from [[CP Pharma]] or, if you are in North America, the compounded PZI in various strengths available from BCP and VPOA (US) and Summit (Canada).
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==CP Pharma==
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=== CP Pharma ===
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[[Image:69 main.jpg|thumb|190px|left|Hypurin Bovine Protamine Zinc-U100 all-beef PZI insulin.]]'''[[Hypurin Bovine Protamine Zinc]]''' is a U100 100% bovine PZI manufactured by [[CP Pharma]]. It is approved for use in [http://bnf.org/bnf humans] and can be imported into the US and other countries.
 
[[Image:69 main.jpg|thumb|190px|left|Hypurin Bovine Protamine Zinc-U100 all-beef PZI insulin.]]'''[[Hypurin Bovine Protamine Zinc]]''' is a U100 100% bovine PZI manufactured by [[CP Pharma]]. It is approved for use in [http://bnf.org/bnf humans] and can be imported into the US and other countries.
   
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Those CP Pharma insulins are comparable to [[Insuvet Protamine Zinc]], made by [[Schering-Plough Animal Health]], a U100, 100% bovine PZI for veterinary use that is only available in the UK.
 
Those CP Pharma insulins are comparable to [[Insuvet Protamine Zinc]], made by [[Schering-Plough Animal Health]], a U100, 100% bovine PZI for veterinary use that is only available in the UK.
   
CP Pharma actually produces the [[Schering-Plough Animal Health]] [[Insuvet]] insulins<ref>[http://www.wockhardt.com/part_europe.html CP Wockhardt UK-Producer of Insuvet Insulin Line for SPAH]</ref>.
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CP Pharma actually produced the Schering-Plough Animal Health [[Insuvet]] insulins<ref>[http://www.wockhardt.com/part_europe.html CP Wockhardt UK-Producer of Insuvet Insulin Line for SPAH]</ref>. After the Insuvet line was sold to [[Pfizer Animal Health]], it's believed that Pfizer still contracts CP/Wockhardt UK for their production.
 
==Importing-Canada==
 
Your vet may also be able to obtain manufactured PZI insulin for you through Health Canada's Emergency Drug Release program<ref>[http://www.hc-sc.gc.ca/dhp-mps/vet/edr-dmu/edr-dmu_e.html Health Canada-Veterinary: Emergency Drug Release Information]</ref>. With it, you are able to receive up to 6 months worth of insulin; a C$ 50.00 fee for the application is required
 
<ref>[http://www.hc-sc.gc.ca/dhp-mps/vet/applic-demande/form/edr-dmu_form_e.html Health Canada-Emergency Drug Release Form]</ref>. If permitted, you would then be eligible to import PZI insulins such as [[PZI Vet]],[[Insuvet Protamine Zinc]], [[Hypurin Vet Protamine Zinc]], or [[Hypurin Bovine Protamine Zinc]], as well as the other insulins [[Insuvet]] and [[CP Pharma]] produce.
 
 
The program is similar to Health Canada's Special Access Programme <ref>[http://www.hc-sc.gc.ca/dhp-mps/acces/drugs-drogues/index_e.html Health Canada-Special Access Programme]</ref> for importing necessary drugs for people.
 
   
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==Compounded==
 
==Compounded==
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Compounded insulins typically have shorter lifespans and there are fewer quality controls in place than with manufactured insulins to ensure the highest consistency insulin reaches the consumer.
 
=='''SVP PZI'''==
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'''Specialty Veterinary Pharmacy '''in Houston, TX, USA, Compounds (40u and 100u) PZI insulin (pure BEEF)
   
==BCP PZI==
 
   
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[http://www.svpmeds.com www.svpmeds.com] Phone 1-877-673-3705
'''[[BCP PZI]]''' is a bovine-origin PZI-based insulin. Because it's beef based, its amino acid chain is almost the same as that of a cat, so it's especially well-matched to cats.
 
   
 
=== BCP PZI ===
[[BCP Veterinary Pharmacy]]<ref>[http://www.bcpvetpharm.com/ BCP Veterinary Pharmacy Website]</ref> in Houston, TX, USA, manufactures and is the sole source supplier for [[BCP PZI]]. [[BCP PZI]] is commonly used in diabetic cats in the U.S. [[BCP PZI]] is a compounded insulin.
 
 
'''[[BCP PZI]]''' is a bovine-origin PZI-based insulin. Because it's beef based, its amino acid chain is almost the same as that of a cat, so it's especially well-matched to cats.
   
 
[[BCP Veterinary Pharmacy]]<ref>[http://www.bcpvetpharm.com/ BCP Veterinary Pharmacy Website]</ref> in Houston, TX, USA, manufactures and is the sole source supplier for [[BCP PZI]]. [[BCP PZI]] is commonly used in diabetic cats in the U.S. [[BCP PZI]] is a compounded insulin. Now that other pharmacies are discontinuing their bovine insulin, BCP Veterinary Pharmacy will most likely be the sole producer of Pure Beef PZI insulin in the U.S.
==VPOA PZI==
 
   
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=== VPOA PZI ===
 
All-Beef 40U PZI insulin is available from [http://www.vetrxrx.com/ Veterinary Pharmacies of America] in Houston, Texas, a source recommended by Dr. E. Hodgkins.<ref>[http://www.felinediabetes.com/pzi-sources.htm Sources of PZI in various countries, collected by Rebecca Price of FDMB]</ref>
 
All-Beef 40U PZI insulin is available from [http://www.vetrxrx.com/ Veterinary Pharmacies of America] in Houston, Texas, a source recommended by Dr. E. Hodgkins.<ref>[http://www.felinediabetes.com/pzi-sources.htm Sources of PZI in various countries, collected by Rebecca Price of FDMB]</ref>
   
BCP, VPOA, and other compounding pharmacies are the only US source for pure beef insulin of any type. Manufactured beef insulins must be imported from [[CP Pharma]].
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BCP, VPOA, and other compounding pharmacies are the only US source for pure beef insulin of any type. Manufactured beef insulins must be imported from [[CP Pharma]].
   
 
=== UK, Canada, and US-other compounded PZIs ===
 
Those in Canada can obtain 100% beef compounded PZI in U100 strength from Summit Veterinary Pharmacy<ref> [http://www.svprx.ca/ Summit Veterinary Pharmacy Website]</ref> in Ontario. Summit sells their insulin solely through vets--yours will need to place the order for you.
   
 
Summit's insulin is comparable to [[Insuvet Protamine Zinc]], and the [[Hypurin Bovine Protamine Zinc]] and [[Hypurin Vet Protamine Zinc]] insulins of [[CP Pharma]].
==UK, Canada, and US-other compounded PZIs==
 
   
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There are also pharmacies in the US and UK that compound PZI based on human ("regular") or animal-source insulins. It is possible to have PZI Humulin insulin of any strength compounded at some local compounding pharmacies: this relatively inexpensive route has produced satisfactory results for some cats.<ref>[http://www.felinediabetes.com/pzi.htm#_What_is_PZI? Pet Health: PZI (Protamine Zinc Insulin)]</ref>
Those in Canada can obtain 100% beef compounded PZI in U100 strength from Summit Veterinary Pharmacy<ref> [http://www.svprx.ca/ Summit Veterinary Pharmacy Website]</ref> in Ontario. Summit sells their insulin solely through vets--yours will need to place the order for you.
 
   
 
This link<ref>[http://felinediabetes.com/pzi-sources.htm Felinediabetes.com--PZI Sources]</ref> and this one<ref>[http://www.indulgedfurries.com/petdiabetes/pzi.htm Petdiabetes.org--PZI Source List]</ref> list some of those compounding pharmacies, their contact information, and prices for their insulins.
Summit's insulin is comparable to BCP's U100 strength all-beef PZI, [[Insuvet Protamine Zinc]], and the [[Hypurin Bovine Protamine Zinc]] and [[Hypurin Vet Protamine Zinc]] insulins of [[CP Pharma]].
 
 
There are also pharmacies in the US and UK that compound PZI based on human ("regular") or animal-source insulins. This link<ref>[http://felinediabetes.com/pzi-sources.htm Felinediabetes.com--PZI Sources]</ref> and this one<ref>[http://www.petdiabetes.org/pzi.htm Petdiabetes.org--PZI Source List]</ref> list some of those compounding pharmacies, their contact information, and prices for their insulins.
 
   
 
== Importing-Canada ==
 
Your vet may also be able to obtain manufactured PZI insulin for you through Health Canada's Emergency Drug Release program<ref>[http://www.hc-sc.gc.ca/dhp-mps/vet/edr-dmu/edr-dmu_e.html Health Canada-Veterinary: Emergency Drug Release Information]</ref>. With it, you are able to receive up to 6 months worth of insulin; a C$ 50.00 fee for the application is required
 
<ref>[http://www.hc-sc.gc.ca/dhp-mps/vet/edr-dmu/edr-dmu_e.html Health Canada-Emergency Drug Release Form]</ref>. If permitted, you would then be eligible to import PZI insulins such as [[PZI Vet]],[[Insuvet Protamine Zinc]], [[Hypurin Vet Protamine Zinc]], or [[Hypurin Bovine Protamine Zinc]], as well as the other insulins [[Insuvet]] and [[CP Pharma]] produce.
   
 
The program is similar to Health Canada's Special Access Programme <ref>[http://www.hc-sc.gc.ca/dhp-mps/acces/drugs-drogues/index_e.html Health Canada-Special Access Programme]</ref> for importing necessary drugs for people.
   
   
Line 112: Line 190:
 
*[[:Category:Hypurin Vet PZI cases|Wiki cases--Feline Hypurin Vet PZI users]]
 
*[[:Category:Hypurin Vet PZI cases|Wiki cases--Feline Hypurin Vet PZI users]]
 
*[[:Category:Compounded PZI cases|Wiki cases--Feline Compounded PZI users]]
 
*[[:Category:Compounded PZI cases|Wiki cases--Feline Compounded PZI users]]
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=6298164&query_hl=1&itool=pubmed_DocSum Insulin Therapy in Cats With Diabetes Mellitus-JAVMA-1983]<br>Contains peak, onset, duration data for [[NPH]]/[[isophane]] & PZI insulins in cats.
+
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=6298164&query_hl=1&itool=pubmed_DocSum Insulin Therapy in Cats With Diabetes Mellitus-JAVMA-1983]<br />Contains peak, onset, duration data for [[NPH]]/[[isophane]] & PZI insulins in cats.
 
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=8141485&query_hl=1&itool=pubmed_DocSum Comparison of 2 Ultralente Insulin Preparations With Protamine Zinc Insulin in Normal Cats-American Journal of Veterinary Research-1994]
 
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=8141485&query_hl=1&itool=pubmed_DocSum Comparison of 2 Ultralente Insulin Preparations With Protamine Zinc Insulin in Normal Cats-American Journal of Veterinary Research-1994]
 
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2261761&dopt=Abstract Absorption Kinetics of Regular (Neutral), Isophane (NPH) and Protamine Zinc Insulin (PZI) in Normal Cats-Domestic Animal Endocrinology-1990]
 
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2261761&dopt=Abstract Absorption Kinetics of Regular (Neutral), Isophane (NPH) and Protamine Zinc Insulin (PZI) in Normal Cats-Domestic Animal Endocrinology-1990]
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6298164&dopt=Abstract Insulin Therapy in Cats with Diabetes Mellitus-JAVMA-1983]<br>Some feline Time Activity information on NPH/isophane & PZI insulins.
+
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6298164&dopt=Abstract Insulin Therapy in Cats with Diabetes Mellitus-JAVMA-1983]<br />Some feline Time Activity information on NPH/isophane & PZI insulins.
  +
*[http://images3.wikia.nocookie.net/petdiabetes/images/9/91/08Abstracts_OralPres.pdf Clinical Study Evaluating & Comparing Recombinant PZI With Bovine/Porcine PZIVet-ACVIM 2008-Oral Presentations-Page 30, Abstract #97 & #98]
   
   
  +
[[Image:Wikidog3.jpg|100px]]
  +
  +
*[http://web.archive.org/web/20090306143939/http://www.uq.edu.au/ccah/docs/diabetesinfo/link1.pdf University of Queensland Dosing Information on PZI for dogs]
   
   
Line 124: Line 206:
 
*[http://www.felinediabetes.com/pzi-sources.htm List of sources and prices for PZI insulins worldwide]
 
*[http://www.felinediabetes.com/pzi-sources.htm List of sources and prices for PZI insulins worldwide]
 
*[http://www.bcpvetpharm.com BCP Contact information]
 
*[http://www.bcpvetpharm.com BCP Contact information]
 
*[http://web.archive.org/web/20060613202518/http://diabetic-help.com/kANIMINS2.txt Characteristics of Animal Insulins]
*[http://bnf.org/bnf/ British National Formulary]Access to BNF is free but you must register and log in to use it.
 
*[http://www.diabetic-help.com/kANIMINS2.txt Characteristics of Animal Insulins]
 
 
*[http://www.inchem.org/documents/pims/pharm/insulin.htm#SubSectionTitle:3.3.2%20Properties%20of%20the%20locally%20available%20formulation Protamine Zinc] insulin information--InChem
 
*[http://www.inchem.org/documents/pims/pharm/insulin.htm#SubSectionTitle:3.3.2%20Properties%20of%20the%20locally%20available%20formulation Protamine Zinc] insulin information--InChem
*[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=538471&blobtype=pdf Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Association Journal 1938]<br> This dates back to 2 years after PZI was introduced. Though these are human experiences, it may provide some insight into using pure beef PZI. "Unmodified Insulin" referred to is today's R/Neutral type.
+
*[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=538471&blobtype=pdf Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Association Journal 1938]<br /> This dates back to 2 years after PZI was introduced. Though these are human experiences, it may provide some insight into using pure beef PZI. "Unmodified Insulin" referred to is today's R/Neutral type.
 
==References==
 
<references/>
 
   
  +
Insights like this liven things up aornud here.
[[Category:Insulins]][[Category:long-acting]][[Category:intermediate-acting]]
 
  +
Insights like this liven things up aornud here.
[[Category:Terms]]
 
[[Category:Veterinary]][[Category:Bovine]][[Category:Porcine]][[Category:Rx Status]]
 
[[Category:Long-acting]][[Category:Intravenous use NO]]
 

Latest revision as of 13:07, 25 August 2014

Various types of veterinary insulins are known as PZI, "Protamine Zinc Insulin" . The ones we use most often for animals are a combination pork/beef-derived insulin or a beef-derived insulin. Because most are veterinary insulins, PZIs are not available at normal human pharmacies.

The only PZI insulin still available for people is CP Pharma's Hypurin Bovine Protamine Zinc and it must be imported from the UK.

PZI veterinary insulins are intermediate-acting to long-acting, and can be closer in molecular structure to a cat or dog's own insulin than human-type or analog insulins. Veterinary PZI is a particularly good insulin type for cats. PZI is rarely used in dogs but is considered when other insulins are not effective[1].

NB:Animal-source insulins are becoming harder to make now, and PZIVet's recent discontinuation (see below) is likely the first in a tragic series that will make porcine and bovine-source insulins rare. We can hope that new GM insulins will shortly be introduced to make up the gap.In the meantime the alternatives include these other PZI insulins, and of course the human GM analogs Levemir and Lantus.


PZI itself was introduced in 1936; it was the first insulin having any type of suspension. Before PZI, the only insulin available was R/Neutral, having no additives to alter or extend its action. Until then, many with diabetes had to get up during the night to take an insulin injection because R/Neutral did not last long enough for an uninterrupted night's sleep[2] .

Felineinsulin8

Feline insulin compared to Bovine, Porcine and Human versions. Up to 4 amino acids differ. The closest match to feline is bovine with only one amino acid difference; the least close is human with four amino acid differences[3].

Use and Handling

Cats tend to do well on PZI insulins. A 2001 study by Dr. Richard Nelson[4][5] showed that 75% of previously treated hard-to-regulate cats did well with the insulin. He goes on to saythat most cats do require PZI twice daily. The other 25% of tested cats did not reach peak with PZI insulin until 9 hours + after injection; they would likely be able to use only one shot per day. As the study illustrates, absorption, peak and duration of PZI is variable.

According to the UK's National Health Service[6], in cases where a shorter-acting insulin is needed in addition to the PZI, the protamine zinc insulin must always be injected separately--NO mixing--due to the excess of protamine in the insulin formula[7][8][9].

Technical details

PZI contains more zinc and protamine than NPH/isophane insulin and it is primarily the extra protamine which gives it its long-acting duration. The additional protamine in the suspension[10] must first be broken down by proteolytic enzymes AKA proteases[11], before the insulin in PZI can be absorbed. NPH/isophane insulin contains less protamine than PZI does and because there's less, it is an intermediate-acting insulin.

No Combining For PZI

Protamine Zinc PZI[12] insulin cannot be combined with other insulins, due to the amount of protamine in the insulin's formula[13][14].


Specifications of PZI

British National Formulary defines protamine zinc insulin as a sterile suspension of insulin in the form of a complex obtained by the addition of a suitable protamine and zinc chloride.

British Pharmacoepia (BP) and United States Pharmacoepia (USP) definitions[15][16]:

Protamine Zinc Insulin

Sterile buffered suspension of mammalian insulin to which protamine and zinc chloride are added. White suspension. pH 6.9 - 7.5 iso-osmotic with blood. Contains for each 100 units of insulin, 1 - 1.7 mg of protamine sulphate and zinc chloride equivalent to 200 per g of zinc, 10 - 11 mg of sodium phosphate.

Protamine Zinc Insulin

Buffered sterile suspension to which zinc chloride and protamine sulphate are added. 40, 80, 100 units/ml. Also contain glycerol, cresol, phenol, sodium phosphate for each 100 units of insulin in addition to protamine and zinc.

Types of Veterinary PZI

Manufactured

These are manufactured, not compounded, insulins. This means the insulin keeps longer, and is less likely to vary, as compounded insulins can, from batch to batch. The manufactured insulins (except ProZinc) have a shelf life of three years (unopened).

ProZinc™

Prozinc

ProZinc™ BIV's U-40 recombinant human insulin

ProZinc™ (protamine zinc recombinant human insulin) isBoehringer Ingelheim Vetmedica's replacement for PZI Vet insulin.  Boehringer Ingelheim Vetmedica was the purchaser of the PZI Vet franchise from IDEXX.  ProZinc is a manufactured (not compounded) U-40 insulin with FDA approval for use in diabetic cats.  Dosing is expected to be similar to PZI Vet insulin.  According to a BIV technical representative, during efficacy trials cats were switched from PZI Vet insulin to ProZinc in a 1:1 dosing ratio and they did "well."  It comes in 10ml bottles and has a shelf life of two years from the date of manufacture.  Like other insulins it must be kept refrigerated.  Generally ProZinc should be given twice a day.  It's characteristics (onset, peak, duration etc.) should approximate if not mirror the old PZI Vet insulin.  Since this is a new insulin [Nov 2010] and the supply is on "allocation," supplies may be limited during the immediate future.  It is available online, though some vets and some pharmacies.

PZI Vet (IDEXX)

25934-1

PZI Vet by IDEXX-a U40, 90% beef, 10% pork protamine zinc insulin.

PZI Vet was made by IDEXX Laboratories (formerly Blue Ridge). PZI Vet is a

beef/pork PZI insulin commonly used in diabetic cats in the U.S. Some compounding pharmacies may refer to their PZI insulins as PZI Vet, but you aren't using PZI Vet.[17] unless it is made by IDEXX Labs. Unlike the other PZI's below, PZI Vet is a mix of beef and pork insulin. Beef insulin is closest to a cat's own insulin, and pork is identical to a dog's. PZI Vet is a manufactured insulin; the formula is that of Lilly's 90% beef/ 10% pork Iletin I Protamine Zinc insulin; Blue Ridge purchased it from Eli Lilly after the firm discontinued it.

Note: IDEXX PZI is being discontinued shortly due to animal insulin supply problems:

April 8, 2008

Dear Concerned Cat Owner,

Recently there have been some developments regarding the availability of PZI VET® (protamine zinc 
insulin), and I wanted to update you on the situation because it may impact your diabetic cat. You
may know that PZI VET is derived from bovine and porcine pancreatic glands, and unfortunately, the 
supply of our original raw material has been exhausted. As there are no FDA approved facilities for
harvesting bovine pancreatic tissue, we have determined after extensive study that further 
production of animal source insulins is not practical in a modern manufacturing environment.

Therefore, following the sale of our existing inventory, IDEXX will no longer manufacture or sell 
any animal-based insulin. We are currently in the process of notifying veterinarians who prescribe 
PZI-VET of the situation. As of April 1, 2008, there was a considerable inventory in distribution,
so please consult with your own veterinarian on the best course of action for your cat.


We appreciate that feline diabetes is a chronic condition requiring ongoing treatment and 
monitoring.
Accordingly, IDEXX remains committed to the treatment of this disease. We are working diligently to
develop and bring to market a new insulin product for the treatment of diabetes in cats.

Sincerely,


Cynthia Cole DVM, PhD, DACVCP
Manager, Professional Services Group
IDEXX Pharmaceuticals, Inc.

Insuvet PZI

91 main

Insuvet Protamine Zinc--pure beef U100 PZI insulin.

Insuvet Protamine Zinc or Insuvet PZI is a PZI from Insuvet, similar to BCP's PZI above. Insuvet also makes two other veterinary insulins.

Schering-Plough Animal Health contracted CP Pharma to produce its Insuvet line of bovine insulins[18]. The Insuvet line was sold to Pfizer Animal Health and it is believed that Pfizer continues to contract CP/Wockhardt UK for their production. Some UK pet pharmacies offer both the Insuvet-branded and the Hypurin-branded insulins. The only difference here may be pricing.

Insuvet insulins are only available in the UK; the option for those in other countries is either importing from CP Pharma or, if you are in North America, the compounded PZI in various strengths available from BCP and VPOA (US) and Summit (Canada).

CP Pharma

69 main

Hypurin Bovine Protamine Zinc-U100 all-beef PZI insulin.

Hypurin Bovine Protamine Zinc is a U100 100% bovine PZI manufactured by CP Pharma. It is approved for use in humans and can be imported into the US and other countries.

CP Pharma also produces Hypurin Vet Protamine Zinc, which is pure beef but not offered outside of the UK.

Those CP Pharma insulins are comparable to Insuvet Protamine Zinc, made by Schering-Plough Animal Health, a U100, 100% bovine PZI for veterinary use that is only available in the UK.

CP Pharma actually produced the Schering-Plough Animal Health Insuvet insulins[19]. After the Insuvet line was sold to Pfizer Animal Health, it's believed that Pfizer still contracts CP/Wockhardt UK for their production.

==

Compounded

Compounded insulins typically have shorter lifespans and there are fewer quality controls in place than with manufactured insulins to ensure the highest consistency insulin reaches the consumer.

SVP PZI

Specialty Veterinary Pharmacy in Houston, TX, USA, Compounds (40u and 100u) PZI insulin (pure BEEF)


www.svpmeds.com Phone 1-877-673-3705

BCP PZI

BCP PZI is a bovine-origin PZI-based insulin. Because it's beef based, its amino acid chain is almost the same as that of a cat, so it's especially well-matched to cats.

BCP Veterinary Pharmacy[20] in Houston, TX, USA, manufactures and is the sole source supplier for BCP PZI. BCP PZI is commonly used in diabetic cats in the U.S. BCP PZI is a compounded insulin. Now that other pharmacies are discontinuing their bovine insulin, BCP Veterinary Pharmacy will most likely be the sole producer of Pure Beef PZI insulin in the U.S.

VPOA PZI

All-Beef 40U PZI insulin is available from Veterinary Pharmacies of America in Houston, Texas, a source recommended by Dr. E. Hodgkins.[21]

BCP, VPOA, and other compounding pharmacies are the only US source for pure beef insulin of any type. Manufactured beef insulins must be imported from CP Pharma.

UK, Canada, and US-other compounded PZIs

Those in Canada can obtain 100% beef compounded PZI in U100 strength from Summit Veterinary Pharmacy[22] in Ontario. Summit sells their insulin solely through vets--yours will need to place the order for you.

Summit's insulin is comparable to Insuvet Protamine Zinc, and the Hypurin Bovine Protamine Zinc and Hypurin Vet Protamine Zinc insulins of CP Pharma.

There are also pharmacies in the US and UK that compound PZI based on human ("regular") or animal-source insulins. It is possible to have PZI Humulin insulin of any strength compounded at some local compounding pharmacies: this relatively inexpensive route has produced satisfactory results for some cats.[23]

This link[24] and this one[25] list some of those compounding pharmacies, their contact information, and prices for their insulins.

Importing-Canada

Your vet may also be able to obtain manufactured PZI insulin for you through Health Canada's Emergency Drug Release program[26]. With it, you are able to receive up to 6 months worth of insulin; a C$ 50.00 fee for the application is required [27]. If permitted, you would then be eligible to import PZI insulins such as PZI Vet,Insuvet Protamine Zinc, Hypurin Vet Protamine Zinc, or Hypurin Bovine Protamine Zinc, as well as the other insulins Insuvet and CP Pharma produce.

The program is similar to Health Canada's Special Access Programme [28] for importing necessary drugs for people.


Further Reading

Wikicat3


Wikidog3


Wikicat3Wikidog3

Insights like this liven things up aornud here. Insights like this liven things up aornud here.

  1. Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Page 40
  2. Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Journal-1938
  3. BCP Veterinary Pharmacy-Bovine PZI Insulin
  4. JAVMA 2001: PZI & Hard to Regulate Cats
  5. Antech Diagnostics Newsletter: Hard to Regulate Cats & PZI
  6. NHS UK Excess Protamine Prohibits Same-Syringe Mixing of Protamine Zinc Insulins
  7. Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975
  8. NHS UK-Protamine Zinc Insulin Binds With Soluble (R/Neutral) in Same Syringe
  9. Petsulin Protamine Zinc Page 5-Incompatibilities
  10. PZI Insulin--More Protamine Than NPH/Isophane Insulin
  11. Wikipedia:Proteolytic Enzymes
  12. Excess Protamine in Protamine Zinc Insulin Formula
  13. Comparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975
  14. NHS UK-Protamine Zinc Insulin (PZI) Binds to Soluble Insulin in Same Syringe
  15. British National Formulary Protamine Zinc Insulin
  16. British Pharmacoepia & United States Pharmacoepia Protamine Zinc Insulin Defined
  17. IDEXX Website-PZI Vet
  18. SPAH Contracts CP/Wockhardt UK for Insuvet Insulins
  19. CP Wockhardt UK-Producer of Insuvet Insulin Line for SPAH
  20. BCP Veterinary Pharmacy Website
  21. Sources of PZI in various countries, collected by Rebecca Price of FDMB
  22. Summit Veterinary Pharmacy Website
  23. Pet Health: PZI (Protamine Zinc Insulin)
  24. Felinediabetes.com--PZI Sources
  25. Petdiabetes.org--PZI Source List
  26. Health Canada-Veterinary: Emergency Drug Release Information
  27. Health Canada-Emergency Drug Release Form
  28. Health Canada-Special Access Programme