Chapter 44 The recommendation for insulin treatment in dogs involves administration of an insulin with intermediate duration of action twice daily. The only currently available intermediate-duration product is recombinant human neutral protamine Hagedorn (NPH) insulin (used extralabel for dogs). Porcine Lente insulin (Vetsulin) has been approved for use in dogs but cannot be sold in the United States at the present time because of concerns with stability and bacterial contamination associated with the manufacturing process. It is uncertain when or if the product will again be available in the United States. There is some experience with this product because it has been and remains in use in Canada and many European countries under the brand name Caninsulin. Using Vetsulin, most dogs require injections every 12 hours for adequate control of blood glucose, with a median dose between 0.75 and 0.78 U/kg per injection (range, 0.28 to 1.4 U/kg) for dogs receiving insulin every 12 hours (Monroe et al, 2005). Using recombinant human NPH insulin, most dogs also appear to require two injections per day, with a median time to glucose nadir of 4 hours (range, 1 to ≥10 hours) and a range for duration of action 4 to 10 hours or longer. The median dose reported for well-controlled dogs is 0.63 U/kg every 12 hours (range, 0.4 to 0.97 U/kg) (Palm et al, 2009). Insulin glargine (e.g., Lantus, Aventis) is a human insulin analog in which the amino acid asparagine has been replaced by glycine within the α-chain and two arginine molecules have been added to the C-terminus of the β-chain. It is intended to be used as a long-acting, basal insulin in humans. There is little clinical information about the use of this product in dogs. It may be useful as a longer acting insulin in patients for which NPH or Lente insulins have too short a duration of action to provide adequate glycemic control with two daily injections. In a small number of dogs, insulin glargine was shown to be safe, providing good to moderate control in most of the patients with a median dose of 0.6 U/kg (range 0.11 to 1.07 U/kg) given every 12 hours. However, the time to glucose nadir was quite variable, and duration of action was not determined (Fracassi et al, 2012). Insulin detemir (Levemir) is a long-acting insulin that is used in humans as a basal insulin. The fatty acid myristic acid replaces threonine at position 30 on the β-chain, which causes strong binding between insulin detemir molecules and binding to albumin to prolong its metabolism. There is very little information about use of insulin detemir in dogs, but, similar to insulin glargine, it may be useful for dogs that need a long-acting product. An equivalent dose of detemir in dogs appears to be 25% of the dose of NPH insulin, and the duration of action may be too long to require dosing every 12 hours (Sako et al, 2011). Evidence-based information about the use of detemir or glargine in dogs is too sparse to make a clear recommendation for dosing frequency. It is very important to determine the duration of action and appropriate dose for each patient by performing glucose curves, which may need to be continued longer than 12 hours.
Canine Diabetes Mellitus
Insulin Therapy
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