Page 840 - Small Animal Internal Medicine, 6th Edition

812 PART VI Endocrine Disorders

BOX 49.5 TABLE 49.2
VetBooks.ir Complications of Diabetes Mellitus in Dogs and Cats Top 10 Negative Psychological and Social Impacts of
Diabetes Mellitus and Its Treatment on the Quality of
Common
Iatrogenic hypoglycemia Life of Owners of a Diabetic Dog
Persistent or recurring polyuria, polydipsia, weight loss MEAN ITEM WEIGHTED
Cataracts (dog) ITEM IMPACT SCORE
Lens-induced uveitis (dog)
Bacterial infection, especially involving the urinary tract Worry about pet’s diabetes -5.92
Chronic pancreatitis Interferes with visiting family -5.68
Recurring ketosis, ketoacidosis and friends
Hepatic lipidosis Worry about the dog -5.58
Peripheral neuropathy (cat) developing cataracts
Systemic hypertension (dog)
Worry about boarding the dog -5.18
Uncommon Worry about dog developing -4.95
Peripheral neuropathy (dog) hypoglycemia
Diabetic nephropathy Having to fit the dog’s needs -4.82
Significant proteinuria into their social life
Glomerulosclerosis
Retinopathy Cost of treating the diabetes -4.11
Exocrine pancreatic insufficiency Worry about future ability to -4.07
Gastric paresis care for the dog
Intestinal hypomotility and diarrhea Having to fit the dog’s needs -3.88
Diabetic dermatopathy (i.e., superficial necrolytic into their work schedule
dermatitis) Restricting the owners vacation -3.88
and work activities
The quality-of-life survey was completed by 101 owners originating
treatment regimen, home monitoring and frequency of eval- from the United Kingdom, United States, Canada, Australia, and
uations by the veterinarian on the client, and simplifying the Europe.
overall management of the diabetic dog as much as possible From Niessen SJM et al: Evaluation of a quality-of-life tool for dogs
without negatively impacting control of glycemia is impor- with diabetes mellitus, J Vet Intern Med 26:953, 2012.
tant for the long-term success of treating diabetes.

OVERVIEW OF INSULIN PREPARATIONS insulin recommends vigorous shaking of the insulin vial
Types of insulin typically used for home treatment of diabe- until a homogeneous milky suspension is obtained before
tes in dogs and cats include intermediate-acting insulin withdrawal of the insulin into the syringe.
(NPH, lente) and long-acting basal insulin (protamine zinc Recombinant DNA technology has been applied for the
insulin [PZI], insulin glargine, insulin detemir; Table 49.3). production of insulin analogs with faster and slower absorp-
NPH (Humulin N, Novolin N) is a recombinant human tion characteristics than are seen with native human insulin
insulin; lente (Vetsulin, Caninsulin) is a purified pork-source preparations. Rapid-acting insulin analogs, including insulin
insulin that is a mixture of three parts short-acting amor- lispro (Humalog), insulin aspart (Novolog), and insulin glu-
phous insulin and seven parts long-acting microcrystalline lisine (Apidra®) and are typically administered to human
insulin; and PZI (Pro-Zinc, IDEXX) is a recombinant human patients with diabetes three times a day before each of the
insulin. Porcine-source lente and protamine zinc insulin are three main meals (breakfast, lunch, and dinner), are used to
approved by the FDA for treatment of diabetes in dogs and control postprandial hyperglycemia, and are referred to as
cats, respectively. prandial insulin preparations. The role, if any, of these
NPH insulin, insulin glargine, and insulin detemir are extremely short-acting insulins for the home treatment of
U100 insulin preparations (i.e., 100 units of insulin per mL diabetic dogs remains to be determined. A recent study
of solution), and porcine-source lente and protamine zinc documented similar effectiveness of insulin lispro and
insulin and are U40 insulin preparations (i.e., 40 units of regular crystalline insulin for the treatment of DKA in dogs
insulin per mL of solution). The appropriate insulin syringe (Sears et al., 2012).
should be used for the insulin preparation being adminis- Insulin glargine (Lantus) and insulin detemir (Levemir)
tered (i.e., U40 or U100 insulin syringe for a U40 or U100 are long-acting basal insulin analogs that have a slow, sus-
insulin preparation). Insulin pens are also available for tained absorption from the subcutaneous site of insulin
NPH insulin, porcine-source lente insulin, insulin glargine, deposition, are designed to inhibit hepatic glucose secre-
and insulin detemir. The manufacturer of porcine lente tion, are administered once a day at bedtime, and are used