Veterinary Medicine - May 2008 - (Page c8) “Successful treatment with once-a-day insulin is rare in dogs and uncommon in cats. “ also a human analogue insulin produced by recombinant DNA techniques. As with other human analogue insulins, the name is derived from the names of the amino acids used to alter human insulin. These substitutions result in a shift of the molecule’s pH. Glargine insulin is injected in a clear solution with a pH of 4.0 and forms a microprecipitate at the physiologic, neutral pH of the subcutaneous space. These aggregates result in delayed, prolonged, and relatively constant absorption of insulin from the subcutaneous injection site. Because glargine is acidic, it can not be mixed with a neutral insulin (e.g., regular insulin) or with saline. In people, glargine is used as a oncea-day, long-acting, peakless insulin that mimics the at interprandial insulin secretion in nondiabetics. In diabetic people, the onset of action for glargine occurs two to four hours after subcutaneous injection, and its duration of action is 20 to 24 hours. Glargine is supplemented with a rapid and shortacting insulin (e.g., lispro or aspart) at meal times. A starting glargine dose of 0.5 U/kg subcutaneously every 12 hours appears to be safe and e ective in dogs. However, further studies are needed to better characterize the use of insulin glargine in diabetic dogs because reports on the subject are limited. Insulin detemir. Insulin detemir (Levemir—Novo Nordisk) was approved for use in people by the FDA in June 2005 and has recently become commercially available in the United States. It is another long-acting human insulin analogue; however, there are no published reports on the use of detemir in dogs. Currently, most dogs and cats require twice-a-day insulin treatment (this is the case with any insulin). Successful treatment with once-a-day insulin is rare in dogs and uncommon in cats. With increased use of glargine or detemir, more dogs and cats may do well with only once-a-day treatment. When you combine astute, involved veterinary care with close, constant communication with the client, managing diabetes mellitus can be a success— one that’s rewarding for you, the patient, and the client. References 1. Hess RS, Kass PH, Ward CR. Breed distribution of dogs with diabetes mellitus admitted to a tertiary care facility. J Am Vet Med Assoc 2000;216:1414-1417. 2. Hess RS, Saunders HM, Van Winkle TJ, et al. Concurrent disorders in dogs with diabetes mellitus: 221 cases (1993-1998). J Am Vet Med Assoc 2000;217:1166-1173. 3. Herbst A, Kordonouri O, Schwab KO, et al. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: A multicenter study of 23,251 patients. Diabetes Care 2007;30:2098-2100. 4. Getty L, Hamilton-Wessler M, Ader M, et al. Biphasic insulin secretion during intravenous glucose tolerance test promotes optimal interstitial insulin pro le. Diabetes 1998;47:1941-1947. 5. Fischer U, Hommel H, Ziegler M, et al. The mechanism of insulin secretion after oral glucose administration. VIII. Pancreatic juice insulin excretion after glucose loading and meal ingestion in normal and vagotomized dogs. Endokrinologie 1976;68:327-337. 6. Hirsch IB. Insulin analogues. N Engl J Med 2005;352:174-183. 7. Dailey G, Rosenstock J, Moses RG, et al. Insulin glulisine provides improved glycemic control in patients with type 2 diabetes. Diabetes Care 2004;27:2363-2368. 8. U.S. Food and Drug Administration. FDA approves rst insulin drug for diabetic dogs. Available at: www.fda.gov/bbs/topics/news/2004/NEW01060. html. Accessed March 25, 2008. 8 http://www.fda.gov/bbs/topics/news/2004/NEW01060.html http://www.fda.gov/bbs/topics/news/2004/NEW01060.html
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