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insulin choices for small animals (Proceedings)

October 1, 2011
Cynthia Ward, VMD, PhD, DACVIM

Pathogenesis: Insulin-dependent, non-insulin dependent, and transient

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

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  • 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

  •     

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