Veterinary Medicine - June 2008 - (Page c10)

Table 1. Amino acid comparison of insulin between selected species* Species Feline Bovine Human diabetic cats. Further research is needed to investigate the clinical signi cance of insulin antibodies in cats treated with insulin.9,10 Peptide chain and amino acid number A8 Ala Ala Thr Goals of therapy The goals of therapy are to eliminate the signs of diabetes mellitus (including polyuria and polydipsia) that occur secondary to hyperglycemia and glycosuria, maintain a healthy pet with a stable body weight, and avoid any diabetes-associated complications.11 The bene ts of tight control of blood glucose must be balanced against the risk of life-threatening hypoglycemia.11 A10 Val Val Ile Ile A18 His Asn Asn Asn B30 Ala Ala Ala Thr Porcine/Canine Thr Ala=Alanine; Asn=Asparagine; His=Histidine; Ile=Isoleucine; Thr=Threonine; Val=Valine *Remember: All mammalian insulins irrespective of the species of origin bind with a similar a nity to insulin receptors and initiate post-receptor events in terms of autophosphorylation.2 Dosing and regulation Administration between species. Interestingly, insulin antibodies have been shown to be speci c for conserved regions, not variant residues.8 Immunoglobulin E antibodies mediate allergic reactions to insulin, although immunoglobulin G antibodies may participate.8 In people this can result in insulin allergy and insulin resistance. In human diabetics, the prevalence and titers of anti-insulin antibodies have decreased in the last three decades largely as a consequence of improvements in the puri cation of insulin preparations and the development of mono-component insulins.8 Reactions to insulin containing protamine may be caused by the protamine component—not by the insulin itself. Although allergic reactions to insulin are rare with puri ed insulins,Vetsulin should not be administered to cats that have a systemic allergy to pork or pork products. Interestingly, insulin antibodies appear to have a low prevalence in cats treated with insulin, irrespective of the source (recombinant human, mixed beef-pork, and pork insulin) of the insulin used for treatment.9,10 There also appears to be no clear association between the source of the insulin, the presence of insulin antibodies, and the occurrence of insulin resistance in insulin-treated 10 Mix Vetsulin by gently rolling the vial before withdrawing the dose.5 Use a U-40 insulin syringe and inject subcutaneously 2 to 5 cm (3/4 to 2 inches) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides.5 Recommended dosage The initial goal is to establish signi cant control of the clinical signs resulting from hyperglycemia while avoiding hypoglycemia. For cats, the initial recommended dose is 1 to 2 U per injection given twice a day at approximately 12-hour intervals (Table 2, page 11). For cats fed twice a day, give the dose concurrently with or right after each meal.5 Efﬁcacy Achieving stability (resolution of clinical signs con rmed by biochemical evidence of well controlled diabetes) may take three to four months. Diabetic remission (the complete resolution of clinical and biochemical evidence of diabetes maintained after discontinuing insulin injections) can also develop during this period but may take much longer.3,4,6 In uncomplicated cases, insulin treatment of diabetic cats without dietary modi cation will result in stable diabetes in

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Veterinary Medicine - June 2008 Contents Leading Off Clinical Exposures Idea Exchange A Challenging Case: Conjunctival Lymphoma in a Cat Updates on Canine Hypoadrenocorticism Product Preview CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller Clinical Edge - June 2008 Table of Contents Managing Diabetes Mellitus in Cats: What Makes it Work? Porcine Insulin Zinc Suspension in the Management of Feline Diabetes Mellitus Monitoring Diabetes Mellitus in Diabetic Cats Feline Diabetes Mellitus: Important Client Communication Points

Veterinary Medicine - June 2008

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