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Diabetes Mellitus: Insulin and Diet - Coggle Diagram
Diabetes Mellitus: Insulin and Diet
Therapy
Goals
1) Evaluate and treat for underlying diseases
2) Improve/control clinical signs
3) Prevent complications (DKA, neuropathy, etc)
4) Avoid hypoglycemia
5) Improve chance of remission Insulin Overview
insulin choices
Characterized by
duration of action
potency
onset of action
Most insulins come in one of two concentrations
U‐100 (100 units/ml)
All human products
Low dose (3/10 cc) preferred for cats
U‐40 (40 units/ml)
Some veterinary products
Regular insulin
short acting U‐100
human insulin
used to treat DKA
Route determines onset and duration of action
IV
Immediate onset
duration = 1‐4 hrs
IM
Onset in <30 minutes
duration = 3‐8 hrs
SQ not used
Higher potency than other insulins; lower doses given
specifically..
:dog:
top choices for dogs
Neutral Protamine Hagedorn
aka
Humulin N
Novolin N
NPH
intermediate acting
U‐100 human recombinant insulin
duration too short in cats
Start at 0.25 U/kg q12 hours
Roll to mix
Porcine Lente Insulin (Vetsulin)
porcine insulin
Biphasic peak in dogs?
mix of soluble and crystalline insulin
Start at 0.25 U/kg q12 hours
Shake to mix
Available as a VetPen
Prime before 1st use
SHAKE
Leave under the skin for a minimum of 5 seconds
Make sure dial returns to “0” position
Drop at needle tip is OK Protamine Zinc Insulin (PZI, ProZinc)
intermediate acting U‐40
:cat:
top insulin choices for cats
Protamine Zinc Insulin (PZI, ProZinc)
unpredictable in dogs
Start at 1 U/cat q12 hours
Roll to mix
intermediate acting U‐40
human recombinant insulin
Glargine Insulin (Lantus, Basaglar)
human recombinant insulin
slowed absorption
Soluble at acidic pH
precipitates at a neutral pH (upon SQ injection)
long duration and “peakless” effect
Occasionally can be given once daily
(highly variable in dogs)
Start at 1 U/cat q12 hours
No mixing required
long‐ acting U‐100
Others
Detemir
Toujeo
Insulin Administration
The syringe MUST match insulin concentration
Use appropriate syringes (U‐100 vs. U‐4o)
Do not dilute
Refrigerate
Labels often say to discard after 4‐6 weeks
Refrigerated shelf life is longer (4‐6 months)
Roll NPH & PZI insulin suspensions and SHAKE Vetsulin
No need to mix glargine and detemir
Consider rotating injection sites
Schedule client education appointment for new diabetics
Dietary Management
In dogs
priority: feed a balanced diet that the dog will reliably eat
Feed 50% DER twice daily
High fiber and complex carbs
may improve glycemic control
can lead to weight loss
Contraindicated in underweight dogs
Avoid high fat due to hyperlipidemia
In cats
weight loss and diet are critical
Set attainable/realistic goals
1‐2% per week
1 kg = 30% change in insulin sensitivity?
recommendation is to reduce carbohydrates,
+/- improve remission rates
feral cat diet is extremely low in carbohydrates
commercial dry cat food is ~50% carbohydrates
be aware of caloric density
Meal feeding can help with portion control
What do you do if a diabetic patient skips a meal or vomits?
If additional vomiting/anorexia occurs, call vet
If once -> ½ the dose
Keep activity constant, as heavy exercise may -> hypoglycemia
Oral Hypoglycemic Drugs
minimal evidence for efficacy of oral hypoglycemics
severe side effects ommon
examples
Sulfonylurea (Glipizide)
Biguanides (Metformin)
Acarbose
Vanadium and Chromium