Veterinary Medicine - May 2008 - (Page c6) Keys to managing canine diabetes mellitus Treatment of diabetic dogs is complex and should involve the following: diet, exercise, insulin therapy, and continued intensive monitoring measures: • Treat dogs with uncomplicated diabetes mellitus as outpatients. • After an initial diagnostic evaluation and in the absence of any concurrent disorder, change the patient’s diet to one with a high concentration of insoluble fiber and complex carbohydrates, yet limited in calories and fat. • Send clients home with a recommendation for a moderate, fixed, and constant exercise regimen and an intermediate-acting insulin at a dose of 0.5 U/kg subcutaneously twice a day after eating. • Instruct clients to keep a daily log of clinical signs, including drinking, urination, eating, and activity level. Clients should record the degree of glucosuria once or twice a day before insulin administration. • Instruct clients not to change the insulin dose and to bring the dog back for a blood glucose curve 10 to 14 days after the initial diagnostic evaluation. Initially, two to three glucose curves performed every 10 to 14 days are needed to determine the proper dose of insulin (although some dogs require only one follow-up glucose curve and others may require more). • After initial regulation, perform a blood glucose curve about every three to four months or as clinical signs suggestive of inadequate glycemic control or other concurrent disease develop. occurs about 45 to 60 minutes after a glucose challenge.4,5 The goal of recent insulin treatment protocols in diabetic people has been to mimic this pattern of physiologic insulin secretion. The protocols use a very short and rapid-acting insulin product that mimics phase one of insulin secretion in combination with a longer-acting insulin that mimics the second phase of physiologic insulin secretion. This pattern of insulin treatment has not yet been reported in dogs, so I do not recommend it at this time. Short-acting insulins calcium concentration that follows results in insulin exocytosis. Pattern of physiologic insulin secretion Normal insulin secretion is biphasic. In the rst phase, a large and rapid increase and decrease characterize insulin secretion. The second phase consists of a smaller, more gradual increase and decrease of insulin secretion. In dogs, the rst phase of insulin secretion lasts about two to ve minutes, and the second phase 6 The Food and Drug Administration (FDA) has approved four short-acting insulins for use in people: regular insulin (Humulin R—Eli Lilly, Novolin R—Novo Nordisk), insulin lispro (Humalog—Eli Lilly), insulin aspart (NovoLog—Novo Nordisk), and insulin glulisine (Apidra—Sano -Aventis). When administered subcutaneously to people, lispro, aspart, and glulisine insulins have a faster onset ( ve to 15 minutes) and shorter duration of action (four to six hours) than regular insulin (in which onset is about 30 to 60 minutes and duration of action is about eight to 10 hours). The relatively slower onset of action and longer e ect of regular insulin may be caused by zinc, which is present in regular insulin and promotes the formation of large insulin hexamers that are slow to di use from the subcutaneous tissue into circulation. Structural changes in lispro, aspart, and glulisine reduce the formation of insulin dimers and hexamers and allow for a more rapid absorption of insulin monomers from the subcutaneous tissue into circulation.6,7 All four short-acting insulin products are clear, colorless, and come in 100 U/ml (U-100) preparations.
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