Page 843 - Small Animal Internal Medicine, 6th Edition

CHAPTER 49 Disorders of the Endocrine Pancreas 815

TABLE 49.4
VetBooks.ir Comparison of Insulin Preparation Dosages Required to Attain Control of Glycemia in Diabetic Dogs

INSULIN DOSAGE (U/kg/injection)
INSULIN
PREPARATION NUMBER MEDIAN RANGE STUDY
OF DOGS
NPH 54 0.8* 0.4-1.9 Lorenzen, 1992
0.4 + 0.3-0.8
Lente 35 0.8 0.3-1.4 Monroe et al., 2005
PZI 17 0.9 0.4-1.5 Della-Maggiore et al., 2012
Glargine 12 0.6 0.1-1.1 Fracassi et al., 2012
Detemir 13 0.2 NR Ford, 2010
Detemir 15 0.3 0.1-0.6 UCD, 2013**
NR: not reported
*Dogs weighing < 15 kg
+ Dogs weighing ≥ 15 kg
**UCD, 2013: Insulin dosage required to attain glycemic control in 15 of 24 diabetic dogs treated with insulin detemir at UC Davis
veterinary hospital; glycemic control could not be attained using detemir in 9 of the 24 dogs.

Published experiences with insulin detemir in diabetic
40 dogs are also limited. Insulin detemir is currently the longest
Blood glucose concentration (mmol/L) 20 * * * * * prolonged duration of effect combined with twice a day
acting insulin preparation for use in diabetic dogs, with a
potential for duration of effect to be 16 hours or longer. The
30
administration is responsible for lower dosage requirements
and a greater likelihood for hypoglyemia with insulin
detemir, compared with NPH or lente insulin (see Table
49.4). In an unpublished study, insulin detemir was effective
in improving control of glycemia in 13 diabetic dogs managed
10
(median, 10 month) period (Ford et al., 2010). Ten of 13
dogs were previously treated with NPH or lente insulin with
0 with home blood glucose monitoring during a 4 to 24 month
poor results. The mean and median insulin dosage on the
0 1 2 4 8 12 24
Week of study last week of evaluation was 0.45 and 0.22 U/kg/injection,
respectively. Biochemical hypoglycemia (blood glucose <
FIG 49.2 60 mg/dL; 3.4 mmol/L) was identified in approximately 2%
Box plots of 12-hour mean blood glucose concentrations in of all blood glucose measurements and occurred on average
the blood glucose curves for 12 dogs with diabetes mellitus 7.5 times per dog during the study. Our experiences with
treated by various doses of insulin glargine administration
twice daily for 24 weeks. Twelve-hour mean blood glucose insulin detemir in dogs have been mixed but better than our
concentration is the mean of the seven blood glucose experiences with insulin glargine. The absorption of insulin
concentrations measured during a 12-hour period. The detemir from the subcutaneous site of injection is variable.
horizontal line represents the median, the box represents the In some diabetic dogs the absorption is slow and sustained,
interquartile range (i.e., 25%-75%), the T-bars represent the resulting in relatively flat blood glucose curves. In other dogs
main body of data. *=P <0.05. (From Fracassi F et al: Use the absorption is similar to that seen with intermediate-
of insulin glargine in dogs with diabetes mellitus, Vet Rec acting insulin preparations like lente, resulting in “U”-shaped
170:52, 2012.).
blood glucose curves. The most common problem with
insulin detemir has been hypoglycemia when insulin detemir
and somewhat disappointing. We have been unable to attain is given twice a day. We do not consider insulin detemir a
good glycemic control in the majority of diabetic dogs first choice insulin for the treatment of diabetes in dogs but
treated with insulin glargine. We do not consider insulin consider it the insulin of choice in diabetic dogs with prob-
glargine a first choice insulin for the treatment of diabetes in lems of short duration of effect of NPH and lente insulin.
dogs but do consider using insulin glargine in diabetic dogs Our starting dosage for insulin detemir is 0.1 U/kg twice a
with problems of short duration of effect of NPH and lente day.
insulin and problems with prolonged duration of effect of Although recombinant human PZI, insulin glargine, and
insulin detemir (see page 826). insulin detemir are effective in controlling glycemia in some