Veterinary Medicine - May 2008 - (Page c7) Managing diabetes mellitus in dogs: An overview Regular insulin may be administered intravenously, intramuscularly, or subcutaneously in dogs. In veterinary medicine, regular insulin is used mainly for the treatment of diabetic ketoacidosis and is administered intravenously as a continuous rate infusion, or intramuscularly. The clinical use of lispro, aspart, or glulisine insulins for treating diabetic ketoacidosis in dogs has not yet been reported. Intermediate-acting insulins Intermediate-acting insulin products are the most commonly used insulin products in diabetic dogs. These products are termed intermediate-acting because the overwhelming majority of dogs require twice daily treatment with these products. The three intermediateacting insulin products are white and uniformly cloudy after gentle mixing. Porcine insulin zinc. Puri ed porcine insulin zinc (Vetsulin [Caninsulin]—Intervet) is a lente insulin and is the only FDA-approved insulin for dogs.8 It is marketed in a 40 U/ml (U-40) preparation, and appropriate U40 syringes must be prescribed for its use. Porcine insulin is structurally identical to canine insulin. See Use of porcine zinc insulin suspension in the management of canine diabetes mellitus (page 9) for more information on porcine insulin. Neutral Protamine Hagedorn. Neutral Protamine Hagedorn (NPH) insulin (Humulin N—Eli Lilly, Novolin N—Novo Nordisk) is an isophane suspension and is currently produced by recombinant DNA technology utilizing a nonpathogenic laboratory strain of Escherichia coli. It is identical to human insulin, and, as is the case with all insulin products marketed for use in people, it is marketed in a 100 U/ml (U-100) preparation and must be used with U-100 syringes. Protamine zinc insulin. The production of PZI insulin by IDEXX has been discontinued, and it is recommended to switch cats currently treated with PZI to a di erent insuln. Protamine zinc insulin (PZI, PZI VET—IDEXX) was composed of a mixture of 90% beef and 10% pork insulin. Similar to NPH insulin, PZI insulin contained the sh protein protamine and zinc, which facilitated delayed absorption and prolong the duration of action. It was marketed in a 40 U/ml (U40) preparation, and appropriate U-40 syringes were prescribed for its use. During the initial process of determining the appropriate insulin dose, I recommend performing a blood glucose curve every 10 to 14 days and adjusting the insulin dose accordingly. Once you determine an appropriate insulin dose, performing a blood glucose curve every three or four months may be adequate in the absence of clinical signs suggestive of poor regulation. The best way to determine when a dog may need a blood glucose curve or an adjustment in its insulin dose is to monitor clinical signs suggestive of poor diabetic control. Clients should keep a daily log and record the body weight and amount of drinking, urination, eating, activity and glucose, and ketones observed in the urine. If the dog does not consume its entire meal or vomits, clients should administer half the insulin dose (a dose of insulin should not be skipped) and contact their veterinarian. Clients should also contact their veterinarian if the dog is vomiting regularly or not eating consistently. Long-acting insulins “The best way to determine when a dog may need a blood glucose curve or an adjustment in its insulin dose is to monitor clinical signs suggestive of poor diabetic control.“ Insulin glargine. Insulin glargine (Lantus—Sano -Aventis) was introduced in the United States in 2001. It is marketed as a long-acting, peakless insulin for use in people. Glargine is 7
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