Guidelines. successful management. dog and cat. for the. of the diabetic. Product information CANINSULIN. Veterinary technical brochure

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1 Product information Insulin for Dogs and Cats DESCRIPTION Caninsulin is an aqueous suspension of 40 IU per ml of highly purified porcine insulin, 30% as amorphous zinc insulin and 70% as crystalline zinc insulin. MODE OF ACTION Caninsulin is an insulin product with intermediate action. It contains porcine insulin, which is structurally identical to canine insulin. In cases of insulin deficiency and/or decreased insulin sensitivity, the required blood levels can be achieved by using an individually adjusted dose of Caninsulin. The action of Caninsulin on blood glucose concentrations, following subcutaneous administration, peaks in diabetic dogs at about 6-8 hours post-injection and lasts for about hours; in diabetic cats, it peaks at about 4 6 hours and lasts for about 8-12 hours post-injection. INDICATIONS Treatment of diabetes mellitus in dogs and cats. CONTRAINDICATIONS Hypoglycaemia. Caninsulin is not intended for the initial treatment of animals with severe acute diabetes mellitus that are presented in a ketoacidotic state. Must NOT be administered by intravenous route. The use of progestogens (oestrus inhibitors) should be avoided in animals suffering from diabetes mellitus. In entire bitches, ovariohysterectomy may have to be considered. Care must be taken with the use of glucocorticosteroids. Stress and irregular exercise must be avoided. DIRECTION FOR USE Caninsulin should be administered by subcutaneous injection. The dose depends on the degree of deficit in the animal s own insulin production and is therefore different in each case. As a consequence, a dose-titration phase will always be necessary in order to tailor the treatment to each individual animal. Once daily injection of Caninsulin may be sufficient to reduce the blood glucose in some diabetic dogs. Other dogs may require twice daily injections as the duration of action of the insulin may vary within an individual. In diabetic cats, it is necessary to administer Caninsulin twice daily. DOSAGE AND ADMINISTRATION The use of a 40 IU per ml syringe is strongly recommended. Caninsulin should be re-suspended by inverting a few times before each use until a homogenous suspension is obtained. Stabilisation phase DOG: The initial STARTING dose is 0.5 IU/ kg body weight once daily (rounded down to the nearest whole unit). Example: Dog Bodyweight 5kg 10kg 15kg 20kg Starting dose per dog 2 IU once daily 5 IU once daily 7 IU once daily 10 IU once daily Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose by approximately 10% according to clinical signs and the results of serial blood glucose measurement. Alterations in dose should not normally be made more frequently than every 3 to 7 days. In some dogs, the duration of insulin action may require treatment to be administered twice daily. In such cases, the dose per injection must be decreased by 25% and this dose given twice daily. E.g. A 10kg dog receiving 5 IU once daily, the new dose (5 minus 25%, rounded down to the nearest whole unit) would be 3IU per injection initially. The two daily doses must be administered at 12 hour intervals. Further dose adjustments should be made progressively (in 10% increments) as previously explained. To achieve a balance between the generation of glucose and the effect of the product, feeding must be synchronised with the treatment and the daily ration divide into two meals. The composition and quantity of the daily food intake should be constant. In dogs treated once daily, the second meal is usually fed at the time of peak insulin effect. In dogs treated twice daily, feeding coincides with Caninsulin administration. Each meal should be fed at the same time each day. Keep out of reach of children FOR ANIMAL TREATMENT ONLY CANINSULIN CAT: Cats require twice daily Caninsulin administration. The initial STARTING dose depends on the weight and the fasting blood glucose of the diabetic cat (see table below for guidance). However, a maximum of 2 IU should only be given twice daily in the first 3 weeks e.g. an 8kg cat calculated to require 4 IU twice daily should initially receive 2 IU twice daily for the first 3 weeks. Cat Blood Glucose Concentration Starting dose per cat twice daily <20 mmol/l 0.25 IU/kg twice-daily >20 mmol/l 0.5 IU/kg twice-daily Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose according to the results of serial blood glucose measurements. Alterations in dose should not normally be made more frequently than every week. Increments of 1 IU per injection are recommended. Due to the day-to-day variation in the blood glucose response, and the variation in insulin responsiveness that are seen with time, larger or more frequent increases in dose are not recommended. The composition and quantity of the daily food intake should be constant. Maintenance phase in dogs and cats Once the maintenance dose has been reached and the animal is stabilised, a long term management programme needs to be established. The aim should be to manage the animal in such a way as to minimise the variations in its insulin requirement. This includes clinical monitoring to detect under or over dosage of insulin and adjustment of dose if required. Careful stabilisation and monitoring will help to limit the chronic problems associated with diabetes, including cataracts (dogs), fatty liver (dogs & cats), etc. Follow up examinations should be performed every 2-4 months (or more often if there are problems) to monitor the animals health, the owner s records and biochemical parameters like blood glucose and/or fructosamine concentrations. Adjustments to the insulin dose should be based on clinical signs supported by the laboratory results. ADVICE ON CORRECT ADMINISTRATION Administration of Caninsulin must be carried out by an adult responsible for the welfare of the animal. The ability of owners to recognise the clinical signs of hypo- or hyper-glycaemia, and to respond appropriately, is important if control is achieved during maintenance therapy. Polyuria (frequent urination), polydipsia (excessive water intake) and polyphagia (excessive food intake) in combination with weight loss, poor general condition, hair loss or abnormal coat, and lethargy (marked apathy) are the most common clinical signs of hyperglycaemia and requires the administration of insulin or a dose adjustment in insulin to restore blood glucose concentrations to within the normal range. Insulin over-dosage results in signs of hypo-glycaemia. Signs of hunger, increasing anxiety, muscle twitching, stumbling or hind limb weakness or disorientation indicate progression of hypoglycaemia and requires immediate administration of glucose solution and/or food to restore blood glucose concentration. Somogyi effect (rebound hyperglycaemia), is a response to an overdose of insulin sufficient to cause potentially fatal hypoglycaemia. As hypoglycaemia begins to develop, a hormonal counter-regulatory response is triggered which results in release of glucose from hepatic glycogen stores. This results in rebound hyperglycaemia which may also manifest as glycosuria for part of the 24-hr cycle. There is a danger that the Somogyi effect is interpreted as a requirement for increase in the insulin dose rather than a decrease. This can be avoided by basing decisions on serial blood glucose measurements rather than single point measurements. ADVERSE EFFECTS Hypoglycaemia may result from administration of excessive insulin. Oral glucose should be given immediately. Very rare cases of local adverse reactions associated with administration of porcine insulin have been reported in dogs and cats. These reactions are usually mild and reversible. In extremely rare cases, allergic reactions to porcine insulin have been reported. HANDLING PRECAUTIONS Care should be taken when administering. Accidental self-injection can provoke clinical signs of hypoglycaemia, which should be treated by oral administration of glucose. Seek medical advice immediately and show this leaflet or label to the doctor. In sensitised subjects, accidental administration can induce local or general allergic reactions. See Safety Data Sheet for further information. STORAGE Store unopened vials in upright position, between 2 C and 8 C (Refrigerate. DO NOT FREEZE). After first use, opened vials may be stored between 2 C and 25 C, for 6 weeks. Discard any unused portion after 6 weeks. Protect from light. Invert vial several times to ensure consistent suspension of insulin before withdrawing dose. Approval not required under the HSNO Act Registered to: Schering-Plough Animal Health Limited, 33 Whakatiki St, Upper Hutt. Phone: Prescription Animal Remedy (P.A.R) Class I. For use only under the authority or prescription of a veterinarian. Registered pursuant to the ACVM Act 1997, No. A7401. See for registration conditions. For further information see safety data sheet. Registered trademark. Schering-Plough Animal Health Ltd, 33 Whakatiki Street, Upper Hutt. Phone: CAN CAN No part of this brochure may be reproduced in any form without written permission from Intervet/Schering-Plough Animal Health. of the diabetic dog and cat Veterinary technical brochure Guidelines for the successful management

2 Diabetes incidence and ae tiology Introduction Diabetes mellitus due to pancreatic disease Diabetes mellitus is a fairly common endocrine disorder of dogs and cats that results from an absolute or relative insulin deficiency. In general, the prognosis is very good, provided that the diagnosis is made at an early stage and treatment is adequate. Insulin treatment is the cornerstone of successful management, but dietary adjustment and a regular lifestyle are also important. First rate communication between you, the veterinary surgeon, and the pet owner is of major importance. Your attitude to diabetes Vacuolar degeneration of islets of Langerhans in a dog, Haematoxylin and Eosin (HE) stain, 10x. Amyloidosis of islets of Langerhans in a cat, HE stain, 25x. Amyloidosis of islets of Langerhans in a cat, polarized light (left) and Congo red stain (right). mellitus will largely determine the owner's motivation and compliance with treatment. Incidence Photographs courtesy of Pathology Department, Faculty of Veterinary Medicine, University of Utrecht, NL. Estimates of the incidence of diabetes mellitus in dogs Exocrine Cushing s disease diabetes mellitus that is sometimes seen following the and cats range from 1:100 to 1: The disease occurs Severe inflammation or neoplasia of the exocrine Corticosteroids stimulate gluconeogenesis, leading to administration of progestogens to cats. most commonly in middle aged and older dogs and cats. pancreas can also lead to loss of islet function. In these an increase in the blood glucose concentration. This In dogs, there is preponderance among intact bitches cases, diabetes is complicated by exocrine pancreatic stimulates insulin synthesis, which can eventually result in Obesity while in cats the disorder is most frequently seen in insufficiency. exhaustion of the islets of Langerhans. In obesity, tissue receptors have decreased insulin neutered males. Aetiology Diabetes mellitus can originate from either pancreatic or Non pancreatic disease Overproduction of counteracting hormones and insulin Glucose toxicity Glucose toxicity occurs when insulin secretion is reduced by prolonged hyperglycaemia. Prolonged sensitivity. This leads to a greater demand for insulin, which can result in exhaustion of the islets of Langerhans Potential diabetes mellitus non-pancreatic disease. resistance. hyperglycaemia can be due to a number of causes Pancreatic disease Growth hormone excess including the iatrogenic ones listed below. Potential diabetes mellitus, defined as impaired insulin synthesis and/or decreased sensitivity of tissue receptors Endocrine Progesterone induced Iatrogenic to the effects of insulin, results in an increased blood Destruction of endocrine pancreatic tissue can lead to Progesterone produced during the luteal phase induces Corticosteroids glucose concentration that does not yet exceed the renal diabetes mellitus. In dogs, there is some evidence that autoimmune destruction of the islets of Langerhans plays a role in the pathogenesis of diabetes. In cats, the production of growth hormone by the mammary gland. This counteracts the action of insulin. The therapeutic use of corticosteroids can induce diabetes mellitus. threshold. This is seen in intact bitches during metoestrus. At this stage, the problem may still be reversible by spaying (elimination of the progesterone source). amyloid deposition may contribute to the destruction of Pituitary origin Progestogens the islets of Langerhans. At present, pituitary tumours producing growth The use of exogenous progestogens can lead to growth Mild hyperglycaemia may also be encountered in hormone have only been described in cats. hormone excess. Progestogens also have an affinity Cushing s disease and reversal of the cortisol excess may for glucocorticoid receptors. This is responsible for the prevent the development of diabetes mellitus. Reference 1: Panciera DL et al. (1990) J Am Vet Med Assoc 197,

3 Diabetes pathogenesis and clinical signs Complications, due to protein glycosylation, include Extracellular hyperglycaemia cataract (mainly in dogs) peripheral neuropathy (mainly in cats) hyperosmotic plasma blood glucose >renal threshold dehydration of cells glucosuria high urine specific gravity Fructosamine and glycated haemoglobin concentrations also increase due to protein glycosylation. osmotic diuresis Complicated by ketoacidosis Animals may become comatose if the ketoacidosis is severe. hyperglycaemic coma Figure 1 Extracellular hyperglycaemia polyuria polydipsia hypokalaemia hyponatraemia Intracellular energy shortage Figure 2 Intracellular energy shortage fat metabolism gluconeogenesis increases Pathogenesis Hyperosmolar hyperglycaemic non-ketotic syndrome When resistance of target tissues to insulin plays a role in increase of fatty acid concentrations in plasma ketosis protein synthesis decreases cachexia/lethargy polyphagia decreased gamma globulin concentrations increased susceptibility to infections impaired wound healing the disease, insulin levels can be elevated. In these cases, ketoacidosis; ketonuria acidotic coma Diabetes mellitus is a paradox: simultaneous extracellular ketosis is suppressed and blood glucose concentrations hyperglycaemia and intracellular glucose deficiency. can become very high. These animals are usually The consequences of this paradox are shown in Figs 1 and 2. 2a comatose. Diagnosis Transient hyperglycaemia can occur in cats in stress situations, usually where struggling is involved. Clinical signs Diabetes mellitus is not the only cause of polyuria, Fructosamine concentrations are correlated with the average blood glucose concentration over the previous polydipsia and weight loss. Cases should be investigated 1-2 weeks. Blood fructosamine measurement is a valuable There are three distinct clinical pictures in diabetes fully to rule out other causes before starting insulin tool in confirming a diagnosis of diabetes mellitus mellitus treatment. 2b A preliminary diagnosis of diabetes mellitus particularly in cats. uncomplicated based on clinical signs must be confirmed by urine and complicated by ketoacidosis blood tests. hyperosmolar hyperglycaemic non-ketotic syndrome A diagnosis is based on persistent fasting Uncomplicated diabetes mellitus hyperglycaemia and glycosuria. Reference values for blood glucose are approximately mmol/l in The classical signs are normal dogs and mmol/l in normal cats. The polyuria/polydipsia renal threshold is around 10 mmol/l in dogs and around polyphagia 14 mmol/l in cats. If the blood glucose concentration cachexia exceeds this threshold, glucose is excreted in the urine. increased susceptibility to infections (e.g. urinary tract infections) Reference 2a: Rijnberk A. (1996) Clinical Endocinology of Dogs and Cats, Kluwer Academic Publishers, NL. pp Reference 2b: Rijnberk A. (1996) Clinical Endocinology of Dogs and Cats, Kluwer Academic Publishers, NL. pp

4 Successful diabetes management If the animal s condition is critical (dehydration, anorexia, For dogs the daily food intake is usually divided into Cats are often very fussy eaters and usually prefer to eat uraemia, severe hyperglycaemia and glucosuria) and two meals. The first meal is given around the time when they choose. Free access to a measured amount of surgery is contraindicated, intravenous fluid therapy of the morning insulin injection and the second meal the food is often the best option. Diabetic cats can be and insulin administration should be started. Spaying approximately 8 hours later, for dogs on once daily stabilized on their usual diet if need be. can then be carried out as soon as the bitch s condition Caninsulin treatment. has improved sufficiently. On the day of surgery, pre- Clean drinking water should be available at all times. operative fasting will necessitate reducing the insulin For dogs receiving twice daily treatment, feeding occurs A reduction in excessive water consumption indicates dose, e.g. to around 30%. at the time of Caninsulin administration i.e. 12 hours successful management of the diabetes mellitus. apart. Following surgery, regular monitoring of the blood glucose concentration is necessary until the bitch s condition is stable. The response to insulin will Feed for Diabetic Dogs Feed for Diabetic Cats Diabetes management often improve and the insulin demand will decrease accordingly. Diet and feeding schedule The volume and composition of meals should be identical Palatable Nutritionally Balanced Provide Sufficient Calories Consistent Carbohydrate Content Address Individual Needs Consistent Amount, Content & Timing High Quality High Protein Palatable Low Carbohydrate Carbohydrate with Lowest Glycaemic Index (Corn & Sorghum better than Rice) from day to day to avoid changes in insulin requirements. General considerations As this is difficult to accomplish with home-prepared meals, commercial pet food is preferred. Treatment of diabetes mellitus is likely to succeed only if the pet owner understands all aspects of its Commercial diets with a high quality, highly digestible management, including dietary regulation and a regular protein source and a low fat content provide a more exercise schedule. Investment of time in a careful gradual intestinal uptake of glucose. In animals that explanation of all aspects of diabetes management is are over- or under-weight the ideal body weight strongly recommended. should be reached by gradual weight loss or gain. Very calorie dense diets, especially those high in soluble Spaying carbohydrates, should be avoided. If diabetes mellitus has been diagnosed in an intact bitch, immediate spaying (ovariohysterectomy) is imperative, to prevent further exposure to endogenous progesterone. In animals fit for surgery, this can be carried out prior to insulin treatment and intravenous fluid therapy is administered.

5 Diabetes management with Caninsulin Initial Regulation Due to differences in metabolism, the duration of activity Dogs - Stabilisation Phase of a particular insulin will vary from animal to animal. The source of the insulin can be also different. Caninsulin contains porcine insulin. Porcine insulin is identical to canine insulin, but differs from feline insulin by three amino acids. activity of Caninsulin amorphous (30%) crystalline (70%) Figure 3 Schematic representation of Caninsulin concentration in dogs showing biphasic activity time in hours Caninsulin administration in dogs can be once or twice daily depending on their individual response and requirement. The initial dose for dogs is 0.5 IU per kg body weight once daily (rounded down to the nearest whole unit). Some examples are given in Table 1. Feeding should coincide with Caninsulin treatment, and then again 6-8 hours later to coincide with the peak activity of the insulin. In some dogs, the duration of insulin action may require treatment to be administered twice daily. In such cases, the dose per injection must be decreased by 25% and administered at 12 hour intervals. Some examples are given in Table 2. Feeding should coincide with Dogs Pharmacokinetics of Caninsulin Caninsulin treatment. The duration of activity of Caninsulin may be sufficient to treat dogs once daily. In some cases, injections have Caninsulin is an aqueous suspension of 40 IU of highly Table 1: Starting once daily Caninsulin treatment in dogs. Dog Bodyweight Starting Dose Per Dog Table 2: Starting twice daily Caninsulin treatment in dogs. Dog Bodyweight Starting Dose Per Dog to be given twice daily, particularly if blood glucose concentrations are monitored closely. purified porcine insulin per ml, consisting of 30% amorphous and 70% crystalline zinc insulin. In dogs the amorphous fraction has peak activity 5kg 10kg 15kg 20kg 2 IU once daily 5 IU once daily 7 IU once daily 10 IU once daily 5kg 10kg 15kg 20kg 1 IU twice daily 3 IU twice daily 5 IU twice daily 7 IU twice daily approximately 3 hours after subcutaneous Dogs Maintenance Phase Cats The duration of action of Caninsulin is shorter in cats than in dogs. As a result, all cats require twice daily injections. Twice daily injection of Caninsulin provides administration and its effects last for about 8 hours. Thereafter, the effect is maintained by the crystalline fraction, which has a slower onset of action and peak effects from 7 to 12 hours following injection. 3,4 Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose by approximately 10% according to the clinical signs and the results of serial glucose (glucose curve) measurement. Alterations in dose should not normally be made more frequently than every 3 to 7 days. excellent glycaemic control that can result in remission of the clinical signs in around 25% or more of cases. Afterwards, the effect gradually declines to zero (Fig. 3). In cats, the maximum effect is seen around 4 hours after Cats Stabilisation Phase Cats require Caninsulin administration twice daily. The initial dose for cats is IU/kg twice daily, Table 3: Guide to starting twice daily Caninsulin treatment in cats. Baseline blood glucose concentration Initial Caninsulin dose (round down to nearest whole unit) administration and the total duration of action is around 12 hours. 5 with a maximum dose of 2 IU per injection depending on the initial blood glucose concentration (Table 3). <20mmol/L >20 mmol/l 0.25 IU/kg body weight 0.50 IU/kg body weight A maximum of 2 IU per dose in the first 3 weeks. Cats Maintenance Phase Subsequent adjustment to establish the maintenance dose should be made by increasing or decreasing the daily dose according to the clinical signs and the results of serial blood glucose (glucose curve) measurements. Alterations in dose should not normally be made more frequently than every week. Increments of 1 IU per injection are recommended. Ideally no more than 2 IU per injection should be administered in the first three weeks of treatment. Due to the day-to-day variation in the blood glucose response, and References: 3. Graham PA, Nash AS & McKellar QA. (1997) J Small Anim Pract 38, Horn B & Mitten RW (2000) Aus Vet J 78, Martin GJ & Rand JS (2001) J Feline Med Surg 3, the variation in insulin responsiveness that are seen with time, larger or more frequent increases in dose are not recommended. The composition and quantity of the daily food intake should be constant.

6 Dose adjustment and monitoring Urine monitoring Urine monitoring is a quick and easy method of detecting ketones (ketonuria). Urine only tests positive for glucose if the blood glucose concentration remains above the renal threshold for a substantial period. Monitoring of urine for glucose can be useful in diabetic animals that Blood glucose (mmol/l) Baseline blood glucose Glucose Nadir Duration of action Pre-insulin blood glucose Dose adjustment In dogs, dose adjustment should be managed in steps of 10%. In cats, the dose should be adjusted in steps of 1 IU. Following adjustment, full evaluation should not take place before the new dose has been given a period of at least 3 days, particularly in cats. Maintaining a normal blood glucose concentration throughout the entire day in a diabetic is impossible. The aim is to try to maintain blood glucose concentrations between around 5 and 15 mmol/l for a substantial part of the day. This will result in the are not yet stable or in those that have problems with disappearance of most of the clinical signs - the goal recurrent hypoglycaemia. Here it is used to identify the absence of glucose. Urine monitoring can be used once an animal is known Time of peak effect Time (hours) Figure 4 Blood glucose curve from a Injection stable diabetic dog of therapy. Table 4: Interpreting blood glucose curve results to have a blood glucose concentration in an acceptable range. In this case it is a quick easy method of detecting hyperglycaemia. This should then be investigated further by measuring blood glucose concentrations. Blood glucose (mmol/l) Blood Glucose Curve Results Recommended Action Nadir < 3 mmol/l Decrease dose by 50% Blood glucose curves The most accurate way to assess the response to 10 Clinical Signs of Hypoglycaemia Decrease dose by 50% treatment is by making a blood glucose curve (Figs. 4-7). The procedure is as follows: the first blood sample should ideally be taken just prior to the insulin administration. The animal should be given its first meal followed by its morning Caninsulin injection. Blood samples should then be taken approximately every 2 hours throughout the day (at least 12 hours) Figure 5 Insulin resistance Time (hours) (hyperglycaemia) (see Fig. 7): If hyperglycaemia persists with dosage reduction try increasing the dose. Nadir between 3 5 mmol/l Pre-insulin blood glucose < 10 mmol/l (Dogs) Pre-insulin blood glucose < 15 mmol/l (Cats) Nadir between 5 9 mmol/l and Pre-insulin blood glucose for dogs > 10 mmol/l Pre-insulin blood glucose for cats > 15 mmol/l Decrease dose by 10% (Dogs) Decrease by 1 unit (Cats) Decrease dose by 10% (Dogs) Decrease by 1 unit (Cats) No Change Check the following from the plotted graph: The baseline blood glucose resting blood glucose level just before insulin Blood glucose (mmol/l) Nadir > 9 mmol/l and Pre-insulin glucose values > 15 mmol/l Return to baseline glucose level too soon indicating duration of effect of insulin too short If clinical signs present, increase dose by 10% (Dogs) Increase by 1 unit (Cats) Increase frequency of insulin administration administration The Nadir Lowest blood glucose reading obtained. The pre-insulin blood glucose the last reading just before the next dose of insulin is due to be given. Refer to Table 4 for interpretation of blood glucose curve results Time (hours) Figure 6 Short duration of action: change to twice daily When to Re-evaluate for Insulin Dosage Adjustments Every 2 4 weeks During Initial Stabilisation Period Water Intake > 60 ml/kg/day Signs of Lethargy Weight Loss Change in Appetite Persistent Negative Glucosuria Anytime Hypoglycaemia is Suspected Signs of Good Glycaemic Control Water Consumption < 60 ml/kg/day Normal Appetite Stable Bodyweight Alert and Active Pet Glucosuria, No Ketonuria

7 Challenges in diabetes management Somogyi effect Immediate oral administration of a glucose solution (1 g glucose per kg body weight, approximately one heaped Other hormones, either endogenous or exogenous An insulin dose that is slightly too high may bring teaspoonful per 5 kg body weight) by the owner can When treating an animal for diabetes mellitus, about the Somogyi effect (rebound hyperglycaemia) alleviate these signs. Owners need to keep a glucose medication with progestogens should be discontinued. (Fig. 7). This is a chain of reactions through which the source readily available. Intact bitches should be spayed. body attempts to counteract a decline in blood glucose concentration. If the blood glucose concentration falls Following emergency administration of glucose, food If animals are being treated with corticosteroids, rapidly or approaches hypoglycaemia (less than 5 mmol/l must be given repeatedly at intervals of 1-2 hours until all alternative treatment should be sought. If this is not or 90 mg/dl) following injection of insulin, the animal the effects of the "extra" insulin have been counteracted. feasible, efforts should be made to minimise the will become hungry and restless or lethargic. In response to a declining glucose concentration in the Problems with regulation If the response to insulin therapy is poor, a blood glucose corticosteroid dose. Stress, infections and obesity CNS, adrenaline and subsequently cortisol, glucagon and curve should be made and every effort made to rule out Stress or infections (particularly infections of the oral growth hormone are released. These hormones bring other concurrent or underlying disorders. cavity or urinary tract) can lead to a decrease in the about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from Problems with administration sensitivity of target tissues to insulin. Obese animals have reduced insulin sensitivity. hepatic glycogen and increased peripheral resistance to Problems related to dilution of insulin can be avoided insulin). Polyuria and polydipsia are seen and this can Hyperglycaemia can sometimes persist for days after a by injecting fresh, undiluted insulin. Caninsulin has easily be misinterpreted. single hypoglycaemic episode. If the Somogyi effect is been specially developed for use in animals and has a suspected, an alternative approach involves decreasing concentration of 40 IU/mL, making dilution unnecessary. Blood glucose (mmol/l) the dose by 20% and closely observing the clinical picture. If the polyuria or polydipsia worsen following dose reduction, it is unlikely that the Somogyi effect was the cause of the regulation problems. Problems with resorption from the injection site This has been reported in cats, especially with ultralente insulin. 15 Hypoglycaemia If the insulin dose is too high, clinical signs of Antibodies Antibodies may be directed either against the insulin or 10 hypoglycaemia may be observed. The clinical signs against other foreign proteins in a preparation. Antibody 5 include hunger, restlessness, shivering, ataxia, disorientation, convulsions and coma. However, some production is less likely if homologous insulin is given - the porcine insulin in Caninsulin has exactly the same animals just become very quiet and inappetent. This structure as canine insulin Time (hours) Figure 7 Rebound hyperglycaemia: reduce the dose serious and potentially fatal condition (which can also be triggered by loss of appetite, vomiting or excessive exercise) may occur at any stage, even after stabilisation has been achieved.

8 Diabetic pets can enjoy healthy, normal lives Owner participation Most owners quickly learn to give daily insulin injections. It is best to confirm that the animal is eating normally, before giving the insulin injection. During therapy the pet owner needs to actively participate in monitoring their pet s progress. Initially, monitoring must be carried out on a daily basis but once the animal is stable this frequency can often be decreased. Many owners can be successfully instructed to take capillary blood samples and use a handheld blood glucose meter. If this is not feasible, an alternative is to have the owner test the urine for the presence of glucose and ketones. Before dose changes are made, blood glucose concentrations should be confirmed. Get more information about Caninsulin online More information to help you manage diabetes in dogs and cats is available at. Support material available Starter kits Prognosis in diabetes mellitus You can also visit the website that provides more information for owners of diabetic pets at Fridge magnets Collar tags The prognosis for a diabetic animal depends to a large Syringe samples extent on the level of confidence, knowledge and Owner Education Booklets dedication of its owner. These factors can be favourably influenced by your attitude and the quality of the Waiting Room Posters General Information Brochures information you, the veterinary surgeon, provide. It should be made clear that treating a diabetic animal is rewarding and certainly not as complicated as is sometimes thought.