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Fleeman L, Gilor C. Insulin Therapy in Small Animals, Part 1: General Principles. Vet Clin North Am Small Anim Pract 2023; 53:615-633. [PMID: 36906469 DOI: 10.1016/j.cvsm.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Understanding the pharmacology of insulin and how it relates to the pathophysiology of diabetes can lead to better clinical outcomes. No insulin formulation should be considered "best" by default. Insulin suspensions (NPH, NPH/regular mixes, lente, and PZI) as well as insulin glargine U100 and detemir are intermediate-acting formulations that are administered twice daily. For a formulation to be an effective and safe basal insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
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Affiliation(s)
- Linda Fleeman
- Animal Diabetes Australia, Melbourne, Victoria, Australia.
| | - Chen Gilor
- Small Animal Internal Medicine, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA
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Gilor C, Fleeman LM. One hundred years of insulin: Is it time for smart? J Small Anim Pract 2022; 63:645-660. [PMID: 35560042 DOI: 10.1111/jsap.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/10/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
Smarter understanding of diabetes pathophysiology and pharmacology of insulin therapy can lead to better clinical outcomes. Rather than looking for an insulin formulation that is considered "best" for a general population, it could be appropriate to seek the "smart" insulin choice, tailored to the specific clinical situation. Different treatment goals should be considered, with pros and cons to each. Ideally, insulin therapy in most diabetic dogs should mimic a "basal-bolus" pattern. The "intermediate"-acting insulin formulations might provide better "bolus" treatment in dogs than the rapid-acting formulations used in people. In patients with some residual beta cell function such as many diabetic cats, administering only a "basal" insulin might lead to complete normalisation of blood glucose concentrations. Insulin suspensions (neutral protamine Hagedorn, neutral protamine Hagedorn/regular mixes, lente and protamine zinc insulin) as well as insulin glargine U100 and detemir are "intermediate"-acting formulations that are administered twice daily. For a formulation to be an effective and safe "basal" insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
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Affiliation(s)
- C Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - L M Fleeman
- Animal Diabetes Australia, Melbourne, Victoria, Australia
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Saini NK, Wasik B, Pires J, Leale DM, Quach N, Culp WTN, Samms RJ, Johnson AE, Owens JG, Gilor C. Comparison of pharmacodynamics between insulin glargine 100 U/mL and insulin glargine 300 U/mL in healthy cats. Domest Anim Endocrinol 2021; 75:106595. [PMID: 33307335 DOI: 10.1016/j.domaniend.2020.106595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022]
Abstract
Insulin glargine (IGla) is a synthetic human-recombinant insulin analog that is used routinely in people as a q24h basal insulin. The 300 U/mL (U300) formulation of IGla is associated with longer duration of action and less within-day variability, making it a better basal insulin compared with the 100 U/mL (U100) formulation. We hypothesized that in healthy cats, IGlaU300 has a flatter time-action profile and longer duration of action compared with IGlaU100. Seven healthy neutered male, purpose-bred cats were studied in a randomized, crossover design. Pharmacodynamics of IGlaU100 and IGlaU300 (0.8 U/kg, subcutaneous) were determined by the isoglycemic clamp method. The time-action profile of IGlaU300 was flatter compared with IGlaU100 as demonstrated by lower peak (5.6 ± 1.1 mg/kg/min vs 8.3 ± 1.9 mg/kg/min, respectively; P = 0.04) with no difference in total metabolic effect (ME; P = 0.7) or duration of action (16.8 h ± 4.7 h vs 13.4 h ± 2.6 h; P = 0.2). The greater fraction of ME in the 12- to 24-h period postinjection (35 ± 23% vs 7 ± 8% respectively; P = 0.048) and lower intraday GIR% variability (7.8 ± 3.7% vs 17.4 ± 8.2% respectively; P = 0.03) supports a flatter time-action profile of IGlaU300. There were no differences in onset and end of the action. In summary, although both formulations have a similar duration of action that is well below 24 h, the ME of IGlaU300 is more evenly distributed over a 24 h period in healthy cats, making it a better candidate for once-daily injection in diabetics compared with IGlaU100.
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Affiliation(s)
- N K Saini
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - B Wasik
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - J Pires
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - D M Leale
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - N Quach
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - W T N Culp
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - R J Samms
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN 46140, USA
| | - A E Johnson
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN 46140, USA
| | - J G Owens
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN 46140, USA
| | - C Gilor
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA; Department of Small Animal Clinical Sciences, University of Florida, 2560 SE 16th Avenue, Gainesville, FL 32610, USA.
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Fleeman L, Gostelow R. Updates in Feline Diabetes Mellitus and Hypersomatotropism. Vet Clin North Am Small Anim Pract 2020; 50:1085-1105. [PMID: 32680669 DOI: 10.1016/j.cvsm.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Flash glucose monitoring is a novel, noninvasive monitoring technique that is increasingly used in the management of small animal diabetes. This article provides guidance on the use of flash glucose monitoring in cats and demonstrates how this technique can be used in a range of feline diabetic cases, including those where management is proving challenging. Other aspects of complicated feline diabetic care are also discussed, including management of the sick diabetic cat, potassium depletion myopathy, and treatment options for cats with hypersomatotropism-associated diabetes mellitus. The use of insulin glargine 300 U/ml as a promising new long-acting insulin for diabetic cats is also discussed.
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Affiliation(s)
- Linda Fleeman
- Animal Diabetes Australia, 9-11 Miles Street, Mulgrave, Victoria 3170, Australia
| | - Ruth Gostelow
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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Gilor C, Culp W, Ghandi S, do Carmo Emidio E Silva JA, Ladhar A, Hulsebosch SE. Comparison of pharmacodynamics and pharmacokinetics of insulin degludec and insulin glargine 300 U/mL in healthy cats. Domest Anim Endocrinol 2019; 69:19-29. [PMID: 31280022 DOI: 10.1016/j.domaniend.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/16/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
Abstract
Insulin glargine 300 U/mL (IGla-U300) and insulin degludec (IDeg) are synthetic insulin analogs designed as basal insulin formulations. In people, IGla-U300 is more predictable and longer acting compared with glargine 100 U/mL. The duration of action of IDeg in people is > 42 h, allowing flexibility in daily administration. We hypothesized that IDeg would have longer duration of action compared with IGla-U300 in healthy purpose-bred cats. Seven cats received 0.4 U/kg (subcutaneous) of IDeg and IGla-U300 on two different days, >1 wk apart. Exogenous insulin was measured and pharmacodynamic parameters were derived from glucose infusion rates during isoglycemic clamps and suppression of endogenous insulin. The Shapiro-Wilk test was used to assess normality, and normally distributed parameters were compared using paired t-tests. There was no difference between IDeg and IGla-U300 in onset, peak action, or total metabolic effect. On average, time to peak action (TPEAK) of IGla-U300 was 145 ± 114 min (95% confidence interval [CI] = 25-264) longer than TPEAK of IDeg (P = 0.03) and duration of action (TDUR) of IGla-U300 was 250 ± 173 min (95% CI = 68-432) longer than TDUR of IDeg (P = 0.02). The "flatness" of the time-action profile (as represented by the quotient of peak action/TDUR) was significantly greater for IGla-U300 compared with IDeg (P = 0.04). Overall, insulin concentration measurements concurred with findings from isoglycemic clamps. Based on these data, IDeg is not suitable for once-daily administration in cats. The efficacy of once-daily IGla-U300 in diabetic cats should be further investigated.
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Affiliation(s)
- C Gilor
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA.
| | - W Culp
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - S Ghandi
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - J A do Carmo Emidio E Silva
- Department of Veterinary Clinic and Surgery, UNESP - Univ. Estadual Paulista, Jaboticabal, Via de Acesso Prof. Paulo Donato Castellani, s/n, Jaboticabal, SP 14884-900, Brazil
| | - A Ladhar
- School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, USA
| | - S E Hulsebosch
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
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