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insulin choices for small animals (Proceedings)
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
- 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