Feline Diabetes? Consider Glargine

ArticleLast Updated November 20132 min read

IM administration or CRI of regular insulin has long been accepted as ideal initial treatment for feline diabetic ketoacidosis (DKA); however, regular and glargine insulin, when administered IV in humans, have almost identical effects on blood glucose concentrations and similar duration of action, prompting inquiry into whether this holds true for cats. The aim of this retrospective study was to determine the success and outcome of administering IM glargine, with or without concurrent SC doses, during initial stabilization of DKA in cats.

Glargine insulin was administered IM to 15 cats with DKA based on published protocols for using regular insulin IM; 12 of the cats were also given SC doses of glargine during initial treatment, followed by additional IM and SC glargine doses. Treatment success was based on ketosis resolution, appetite return, and hospital discharge on a regimen of SC glargine insulin with survival past 2 weeks without DKA relapse. All cats survived initial treatment and were discharged from the hospital after a median of 4 days. Median time until all cats were managed with SC glargine as their sole insulin therapy was 24 hours. Based on this and other studies, the current recommendation for DKA is to administer glargine (1 U/cat SC) immediately and concurrent IM glargine (0.5–1 U/cat) several hours after fluid resuscitation before being managed with SC glargine alone.

CommentaryThis study demonstrated successful treatment of DKA using glargine with diabetic remission achieved in one-third of patients. Although glargine has many advantages (eg, decreased cost, use of insulin that can be used long-term), the protocol for IM and SC glargine injections was variable and catered to individuals. This suggests that veterinarians should have a high level of comfort and experience with this insulin and that initial trials using glargine for treatment of DKA should include careful monitoring to avoid hypoglycemic crises as well as electrolyte and mineral imbalances.—Jennifer Ginn, DVM, DACVIM

SourceIntramuscular glargine with or without concurrent subcutaneous administration for treatment of feline diabetic ketoacidosis. Marshall RD, Rand JS, Gunew MN, Menrath VH. JVECC 23:286-290, 2013. ncb