Once-Weekly Insulin Therapy in Dogs

Andrew Bugbee, DVM, DACVIM, University of Georgia

ArticleLast Updated October 20223 min read
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In the Literature

Hulsebosch SE, Pires J, Bannasch MJ, et al. Ultra-long-acting recombinant insulin for the treatment of diabetes mellitus in dogs. J Vet Intern Med. 2022;36(4):1211-1219. doi:10.1111/jvim.16449

The Research ...

Canine diabetes mellitus is traditionally managed with twice-daily insulin injections, but an intensive daily treatment schedule can negatively impact pet owner quality of life and perceived well-being of their pet. 

This study* of 5 client-owned dogs evaluated once-weekly administration of a novel ultra-long-acting (ULA) insulin as an alternative to twice-daily insulin. All dogs were previously diagnosed with diabetes, had been treated with twice-daily insulin therapy for ≥2 months, and demonstrated moderate to good glycemic control. After enrollment in the study, dogs were maintained on a twice-daily insulin protocol and monitored with an implantable flash glucose monitoring system for 10 to 14 days. On day 0, dogs were transitioned to once-weekly ULA insulin, and the flash glucose monitoring system was continued. Weekly evaluation continued for 8 weeks and included full physical examination and measurement of serum drug concentration and antidrug antibody levels; ULA insulin was adjusted as needed based on glycemic monitoring, body weight, and clinical signs. 

ULA insulin therapy maintained a similar level of glycemic and clinical control as compared with twice-daily insulin protocols. Serum ULA insulin concentrations associated with good glycemic control were achieved in all dogs following the second injection, with peak levels reached in week 3. Occurrence of hypoglycemia was not significantly different between baseline and study exit, with biochemical hypoglycemia (<70 mg/dL) occurring in 4.2% of all glucose readings, and a single episode of potential clinical hypoglycemia observed by an owner during the ULA insulin treatment phase.

By week 6, one dog developed antidrug antibodies to ULA insulin and required twice-daily insulin during the final week to achieve glycemic control. The dog remained responsive to prestudy twice-daily insulin, but an attempt to restart ULA insulin after a 2-week washout period yielded no response, suggesting continued presence of antidrug antibodies. In addition, one dog had an incomplete response to ULA insulin therapy after 8 weeks and required intermittent administration of a porcine zinc (lente) insulin with meals.

Once-weekly (ie, ULA) insulin protocols offer a less rigorous treatment schedule for dogs with diabetes mellitus, but other factors—including treatment costs, effective monitoring of long-term therapy, and frequency of potential adverse effects (eg, treatment failure) in a larger population—should be evaluated.

... The Takeaways

Key pearls to put into practice:

  • A novel once-weekly insulin therapy maintained a similar level of diabetic control as compared with traditional twice-daily insulin injections in a small population of dogs. Efficacy of the novel insulin as a first-line therapy in uncontrolled diabetic dogs is unknown and was not evaluated.

  • Hypoglycemia was uncommon during the study period; however, some dogs managed with ULA insulin may require intermittent supplemental conventional insulin therapy to control postprandial hyperglycemia. ULA insulin alone may not be adequate for all dogs to achieve good glycemic control.

  • The once-weekly insulin was designed to be nonimmunogenic, but 1 out of 5 dogs formed antidrug antibodies and required supplemental twice-daily insulin in the final week of the study, warranting evaluation in a larger population of dogs.

*This study was funded by Akston Biosciences.