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
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