Insulin choice and treatment protocol for “healthy” diabetic felines

Abstract

Demand of exogenous insulin administration is currently limited by a series of factors, such as unbalanced pharmacodynamics, low therapeutic index, inconsistent intensity of effect, high physical instability and need for administration by injection. Still, the broad panel of insulin analogues available at the moment has a vital role in the treatment of diabetes mellitus, allowing individualized glycemic control in diabetic cats. The current paper describes the specific treatment protocol for clinically stable diabetic felines, focusing on two types of insulin frequently used in Romania,. Data were collected from the medical records of cats presented at the veterinary teaching hospital of Faculty of Veterinary Medicine of Iasi, Romania. Cases were considered eligible for inclusion in the study if registered with a clear diagnosis of DM and were in a stable clinical condition. Therapeutic protocol focusing on dosing regiments for clinically stable diabetic cats, included two commercially available preparations: glargine and premixed isophane insulin. All cats were treated with both types of insulins and therapy was further continued with the preparation that provided the ideal control of blood glucose level. Diabetes mellitus was diagnosed in 65 cats, of which only 18 were in a stable clinical condition. In 15 cats, ideal control was obtained with insulin glargine, with a median dose of 0.6 IU/kg (range: 0.2-1.1 IU/kg) administered twice daily. Only 3 cases were managed long term with 0.8 IU/kg (0.4-1.9IU/kg) premixed isophane twice daily. The premixed insulin never exceeded a period of action of 8 hours and allowed reinstallation of hyperglycemia on a time interval varying from 2 to 4 hours before the next administration. Insulin glargine provided a good control of blood glucose level, with a very low incidence of subclinical hypoglycaemia episodes and was associated with a higher remission rate of diabetes. Premixed isophane insulin was associated with a blood glucose level to the lower normal range and with frequent hypoglycemia episodes. Also, due to the accelerated metabolism, isophane insulin activity did not reach the second administration in the day, thus cats were hyperglycemic for a varying length of time during the day.