Veterinary Medicine - September 2007 - (Page 604)

Diabetes management O P E E R - R E V I E W E D are also important: Dogs tend to eat defined meals, whereas cats are more likely to graze. The owner’s schedule may also be a factor, and once-daily vs. twice-daily dosing may improve overall compliance (see boxed text “What clients need to know” on page 614). The cost of insulin varies. The veterinary-licensed products are generally more expensive than human ones and require particular syringes (designed for U-40 insulin) that are not available at human pharmacies. The following is intended as a general description of insulin products commonly used in cats and dogs. It does not cover every formulation presently available, and readers are urged to carefully research any unfamiliar type before starting therapy. Doses are provided here as a guide and must always be tailored to a patient’s specific requirements. Regular insulin. Regular insulin is a human recombinant type available in a U-100 concentration (e.g. Humulin R—Eli Lilly, Novolin R—Novo Nordisk). Regular insulin is highly potent and is generally reserved for inhospital use in ketoacidotic animals. It is the only insulin that can be administered intravenously. Careful monitoring is necessary to prevent a precipitous drop in serum glucose concentrations, and it is not an appropriate choice for at-home therapy. Vetsulin. This Lente insulin from Intervet, known as Caninsulin outside the United States, is of porcine origin and comes in a U-40 concentration. It is an aqueous zinc suspension of amorphous and crystalline insulin, which produces two peaks of activity—one soon after administration and the second several hours later.4 Vetsulin is FDA-approved for use in dogs only. It can be used in cats, but insulin resistance secondary to antiinsulin antibodies is a theoretical concern in this species. Some dogs may be adequately controlled with once-daily TABLE 1 A Comparison of Insulin Products Commonly Used in Cats and Dogs Insulin Regular Species of Origin Human Duration Short Comments • Very potent • Can be given IV, IM, or SQ • For in-hospital use only • U-40 product • Approved for dogs • Most patients require twice-daily dosing • Economical choice for large dogs • U-40 product • Approved for cats • May be used once daily in some cats • Shows promise in cats; most receive twice-daily dosing • Adjust dose cautiously using guidelines • Good choice if at-home monitoring is available Vetsulin Porcine Intermediate NPH PZI Human Bovine 90%; porcine 10% Intermediate Long Glargine Human Ultra-long administration, but most dogs require twice-daily dosing.5 I recommend a conservative starting dose of 0.5 U/kg, to minimize the risk of hypoglycemia. Doses should be adjusted based on serial glucose measurements: increase by 10% to 15% in a persistently hyperglycemic patient (glucose > 250 mg/dl), and decrease by 25% if hypoglycemia (glucose 250 mg/dl), and decrease by at least 25% if hypoglycemia (glucose < 70 mg/dl) is noted. Protamine zinc insulin. Protamine zinc insulin (PZI) is 90% bovine origin and 10% porcine origin and is available in a U-40 concentration that is FDAapproved for use in cats (PZI Vet— Idexx). It is a long-acting insulin and is an appropriate choice for diabetic cats. Some cats achieve acceptable glycemic control with once-daily dosing, but twice-daily dosing is more common. The recommended starting dose is 1 U/cat (0.22 to 0.6 U/kg). The dose can be increased in increments of 0.5 U if necessary. PZI is not suitable in dogs because its onset and duration of effect are unpredictable and there is a risk of anti-insulin antibody formation.8 Glargine. Glargine, a human recombinant type, is a new form of in- 604 September 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.