insulin choices for small animals (Proceedings)

Pathogenesis

• Insulin-dependent

• Non-insulin dependent

• Transient

Diagnosis

• Clinical signs

• Persistent hyperglycemia

• Glucosuria

• Stress-related hyperglycemia

• Insulin-dependent versus non-insulin dependent                 

• difficult to separate

• often diagnosed by clinical presentation or in retrospect

Patient evaluation

• Stable versus non stable          

• ketotic

• acidotic

• hyperosmolar

• hydration status

• eating/drinking

• Concurrent disease

•  urinary tract infection

• concurrent endocrinopathies:  cushing's disease, hypothyroidism, hyperthyroidism

• pancreatitis

• infections

• pregnancy

• reproductively intact

• Testing

• CBC

• Chemistry

• Urinalysis

• ketonuria

• bacteriuria

• pyuria                     

• Urine culture

• abdominal ultrasound

• pancreatic lipase immunoreactivity (PLI)

• insulin-dependent versus non-insulin dependent – no good way to differentiate

• Treatment for the stable animal

• ketotic versus non ketotic

• hospitalization versus non hospitalization

• Goals of therapy

• correction of clinical signs

• control of concurrent disease

• avoidance of emergency situations

• hypoglycemia

• ketosis/ketoacidosis

• hyperosmolality

• Treatment for the stable feline diabetic

• diet – low carbohydrate

• diet + insulin

• effects very variable

• intermediate-acting; bid

• 0.25 U/kg; 1-2 U/cat bid

• Treatment for the stable canine diabetic

• diet + insulin

• high insoluble fiber diet; calorie restriction

•  intermediate-acting insulin;

• 0.5 U/kg bid

• Feed bid with insulin

• Exercise

• Identification and control of concurrent disease

• Time for initial control:   4-6 weeks

• Oral hypoglycemic agents – may worsen disease, especially in cats

•  chromium and vanadium

• trace minerals

• insulin sensitizers

• ineffective in dogs

• metformin (biguanide) – not effective in diabetic cats as a sole agent

• glipizide, gyburide (sulfonylurea)

• stimulate insulin secretion

• NIDDM

• worsening of islet cell amyloidosis

• Alpha-glucosidase Inhibitors

• acarbose

• miglitol

• complex oligosaccharides that inhibit enzymes in the brush border of the small intestine responsible for digestion of carbsin diabetic dogs: acarbose decreased dose of insulin necessary

• diarrhea

• weight loss

• 12.5-25 mg/dog at meal time    

Insulin choices

type

Source

Conc

Route

Onset

Duration(d)

Duration©

regular

Human recom

100U/ml

IV

immed

1-2 h

1-2 h

IM

10-30 min

2-6

2-6

SC

30-60 min

2-6

2-6

NPH

Human recom

100 U/ml

SC

0.5-2 h

4-12

4-6

Lente (VetsulinTM)

Pork

40 U/ml

SC

0.5-2 h

6-16

4-16*

PZI

Beef/Pork

40 U/ml

SC

0.5-4 h

6-16

6-16**

PZI (Pro ZincTM)

Human

Recom

40 U/ml

SC

0.5-4 h

6-16

6-16

Glargine

LantusTM

Human mutated

100 U/ml

SC

0.5-1 h

6-16

6-16

Detemir

LevemirTM

Human

mutated

100 U/ml

SC

0.5-1 hr

6-16

6-16

Lispro -HumalogTM

Aspart -NovoLogTM

Human mutated

100 U/L

SC

15 min

2-6 hrs.

2-6 hrs

Short/intermediate acting mixtures

50/50

70/30

75/25

Mixtures of insulins

• *Temporarily unavailable due to manufacturing concerns

** No longer available by IDEXX.  Some compounding pharmacies are selling their own compounds