WHAT’S NEW IN DIABETIC MONITORING IN DOGS AND CATS? CONTINUOUS GLUCOSE
MONITORING AND MORE J. CATHARINE SCOTT-MONCRIEFF, MA, MS, VET MB, DACVIM, DECVIM (continued)
Most newly diagnosed diabetic dogs are treated with Lente or NPH insulin administered twice daily. The typical starting dose for most insulin used in diabetic dogs is 0.25 – 0.5 U/kg. Detemir should be started at a lower dose of 0.1 U/kg. Longer acting insulins such as PZI may be useful in some patients with rapid metabolism of insulin. Although the majority of canine diabetic patients are treated twice daily some dogs treated with Lente insulin can be adequately managed on once a day insulin. Protamine Zinc Insulin has recently been approved by the FDA for once daily administration. There are three insulin products that are appropriate for first line treatment of diabetes mellitus in cats; Protamine zinc insulin, Lente insulin, and Glargine insulin. NPH insulin tends to have a very short duration of action in cats and is not recommended as first line insulin. PZI insulin (ProZInc) There have been two large studies published regarding the use of PZI insulin in cats, one using Beef/pork PZI insulin (PZIVet) and the other using human recombinant PZI insulin (ProZinc). Both studies demonstrated good glycemic control in 85-90% of diabetic cats. Both newly diagnosed cats and cats that had had poor control with other insulin products were included in these studies. In the most recent study of 133 diabetic cats (120 cats with newly diagnosed DM, and 13 cats previously treated cats), PZI insulin was effective in decreasing BG concentration and improving clinical signs in 85% of the cats within 45
days of initiating treatment. All cats were treated with PZI twice daily, and the starting dose was 0.22 – 0.66 U/ kg/injection. The mean insulin dose was 0.59 U/kg/injection at the end of the study (day 45). The nadir of the blood glucose occurred at 5-7 hours post-injection. Hypoglycemia occurred in 22% of the cats and sometimes occurred even when very low insulin doses were used. For this reason, it is recommended that the starting insulin dose should be conservative (1U/ cat/injection) with subsequent dose increases made based upon clinical response to treatment and blood glucose curves. Pork Lente insulin (Vetsulin) Pork Lente insulin has been approved by the FDA for use in cats and it has been used successfully in cats in Europe for several years. Vetsulin is a pure pork insulin which has an intermediate duration of action,
although it has a shorter onset and duration in cats than in dogs. The time from injection to the BG nadir is 4 hours and the duration of effect (time for BG to return to baseline) is approximately 10 hours, so Lente insulin should be administered twice daily in cats. The starting dose for Lente insulin in cats (0.25 -0.5 U/kg/ injection) is similar to that of other insulins, and the median dose required for good glycemic control in a group of diabetic cats was 0.5 U/kg. In this same study, 7 of 25 cats went into diabetic remission during the 12 months of the study and all the cats that remained diabetic had good or excellent control at the conclusion of the study. In a study of 90 cats with diabetes mellitus, 41 cats were treated with Lente insulin and 23 (56%) went into diabetic
remission. (continued)
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