1. Insulin Choices
for Diabetics
Which Insulin should I use?

2. Somogyi Effect
a diabetes mellitus rebound effect in
which an overdose of insulin induces
hypoglycemia. This releases hormones
that stimulate
lipolysis, gluconeogenesis, and
glycogenolysis, leading to hyperglycemia
and ketosis. Treatment involves gradually
lowering the insulin dose to achieve an
optimal level

3. Standard Insulin Preparations
1. Porcine lente zinc suspension
2. Regular insulin
3. Isophane ( NPH) insulin
4. Combinations of 70% NPH and 30%
regular insulin ( Humulin)

4. Porcine lente zinc suspension
 Vetsulin ( coming back on market)
 Effective in dogs and cats
 Intermediate acting
 Combination of 305 short acting semilente
and 70% longer acting ultralente
 Best suited to twice a day
 40 units/ml convenient for small patients

5. Regular Insulin
 100 units/ml
 Management of diabetic ketoacidosis
and ketosis in dogs
 Ex Humulin

6. Isophane ( NPH) Insulin
 Recombinant humen NPH insulin
 Intermediate duration of action
 Treatment of diabetes in dogs,
administered twice a day
 NOT recommended in cats

7. Combinations of 70% NPH and
30% Regular Insulins
 100 units/ml
 Twice day dosing in dogs

8. Newer Insulin Preparations
1. Recombinant human protamine zinc
insulin Prozinc
2. Short-acting insulin analogue
preparations Humalog
3. Insulin glargine
4. Insulin detemir
5. Mixtures of short acting and long acting
analogs

9. Recombinant human
protamine zinc insulin
 Prozinc
 Comparable to PZI-PET ( discontinued)
 40 units/ml
 Not a first choice in diabetic dog less
predictable than Lente or NPH

10. Short acting insulin analogue
preparations
 Lisproinsulin
 Alternative to regular insulin in the dog
with diabetic ketoacidosis

11. Insulin Glargine
 Long acting synthetic insulin
analogue, inhibits hepatic glucose
production
 Genetically modified
 Precipitates in the skin for slower
release, which prevents peaks and
troughs
 Effective for use in cats

12. Insulin detemir
 Synthetic, longer duration due to genetic
engineering
 Binds to plasma proteins, slowly released
 Longer acting in some cats and dogs

13. Mixtures of short acting and
long acting insulin analogues
 Humalog
 No published information on their use in
cats and dogs
 May be effective in cats and dogs as
twice daily

14. Insulin Recommendations in
the Diabetic Dog
 Human NPH insulin or Porcine lente insulin
 If available Vetsulin

15. Humulin or Vetsulin in Diabetic
Dog
 Starting dose for both .25-.5 Units/kg
 Initiate treatment twice a day

16. Humulin 70/30 in Diabetic Dog
 100 units/ml
 30% short acting, 70% long acting
 Similar to Vetsulin
 Twice daily dosing with the meal
 Note: dogs that do not respond well to
Humulin N may respond to this combo

17. Humalog 75/25 or Novolog
70/30 in Diabetic Dogs
 Synthetic mixtures
 Similar action to Humulin 70/30
 Given twice daily with meals

18. Glargine insulin in Diabetic
Dogs
 Unpredictable serum insulin levels
 Failed to produce glucose lowering

19. PZI Insulin in Diabetic Dog
 Effective in a recent study but the
required dosage to achieve these effects
was much higher than other insulin
preparations
 .9 Units/kg ( vs .5 Units/kg for other
preparations)

20. Levemir Insulin in Diabetic
Dogs
 Similar
to effects of glargine in cats
 Good with the brittle diabetic
 Very potent, .1Unit/kg BID at time of
feeding

21. Insulin Recommendation for
the Diabetic Cat
 Can be totally unpredictable in glycemic
response to exogenous insulin
 No single insulin effective for all cats even
if given twice daily
 Many vets prefer ProZinc or Lantus while
others prefer Humulin N as initial insulin
choice
 Be very careful/cautious with insulin in
cats they can go into remission

22. Humulin N or Vetsulin in
Diabetic Cats
 Duration shorter than 12 hours, resulting in
inadequate glycemia control
 Can lead to Somogyi phenomenon
 Many cats can be controlled at .5
units/kg BID or up to 1 unit/kg BID

23. Prozinc Insulin in Diabetic Cats
 Ingeneral these longer acting
preparations work well in newly
diagnosed cats
 Twice a day therapy at 1unit twice a day
to avoid hypoglycemia and Somogyi
effect
 Potency can be a problem with every
batch so not the best choice

24. Lantus Insulin in Diabetic Cat
( Glargine)
 Longest acting commercially available
insulin
 Starting dose .25-.5 Units/kg twice a day
 Initial starting dose should not exceed 2-3
units/cat twice a day
 Necessary to give twice a day for
adequate control of diabetes
 Can lead to remission in cats

25. Levemir Insulin in Diabetic Cats
 Remission rates similar to glargine
 1.75 units/cat twice a day is maximum
dose
 Long term diabetics should be moved
over to glargine or detemir
 High remission rates with proper diet and
twice a day dosing