Therapy

The cornerstones of treatment in diabetic dogs and cats are administration of insulin and a specific diet (Rucinsky et al. 2010; Sparkes et al. 2015). Treatment goals are resolution of clinical signs, control of body weight, and prevention of diabetic complica­tions and episodes of hypoglycemia.

Insulin

Short-acting insulin is preferred in animals with diabetic ketoacidosis or hyperosmolar syndrome, while insulins with an intermedi­ate or long duration are administered in uncomplicated cases. The most widely used insulins and recommended for uncompli­cated DM include:

• Porcine insulin zinc suspension. Duration of effect 8-14 hours in dogs, 6-12 hours in cats. First choice in dogs, with an initial dosage of 0.25 UI∕kg, twice daily. Not first choice in cats, because it can have a short duration.

• Human recombinant protamine zinc insu­lin. Duration of effect 10-16 hours in dogs, 10-14 hours in cats. First choice in cats with a starting dosage of 0.25 UI∕kg, twice daily, without exceeding the dosage of 2 UI∕cat for each administration. Not avail­able in some countries.

• Insulin glargine (recombinant human insu­lin analogue). Duration of effect 8­16 hours in cats (Gilor et al. 2010). First choice in this species (like the above) with an initial dosage of 0.5 UI∕cat for weight 4 kg. Do not exceed 1 UI∕cat if the initial glucose concentration is 180 mg∕dL. In case of poor metabolic control, the insulin dose should be increased in cats by increments of 0.5 UI and in dogs by 1-5 UI (depending on weight). Finally, it is emphasized that blood glucose curves can vary from one day to the next (Fleeman and Rand 2003). Therefore, treat­ment decisions should always be made also considering clinical conditions and concen­trations of fructosamine.