Comparison of lente insulin and NPH insulin therapy for the treatment of newly diagnosed diabetic dogs: a randomised study.

Clinical studies that compare lente insulin and neutral protamine Hagedorn (NPH) insulin in diabetic dogs are lacking. This is a prospective, randomised, controlled clinical study aimed to compare the efficacy and safety of lente insulin and NPH insulin in diabetic dogs. Thirty client-owned, newly diagnosed diabetic dogs were included. Animals were randomised into two groups and received lente insulin or NPH insulin administered every 12 hours. Follow-up re-evaluations were done at 1, 2, 4, 6, 8 and 12 weeks. At each re-evaluation, a physical exam, blood glucose curve, and serum fructosamine concentrations were performed. At the end of the study, the median insulin dose per injection was 0.61 U/kg (range, 0.34-0.92 U/kg) and 0.49 U/kg (range, 0.23-0.68 U/kg) in the lente and NPH groups, respectively. There was a significant improvement of polyuria and polydipsia and glucose concentrations in both groups. At the end of the study, the glycaemic control was considered good in 9/15 (60 per cent) and 11/15 (73 per cent) in the lente and NPH groups, respectively. These differences were not significant. Lente insulin and NPH insulin were similarly effective in the treatment of dogs with diabetes mellitus.

Prospective evaluation of a protocol for transitioning porcine lente insulin-treated diabetic cats to human recombinant protamine zinc insulin.

Objectives The objective was to evaluate a nadir-led protocol for transitioning porcine lente insulin suspension (PLIS)-treated diabetic cats onto human recombinant protamine zinc insulin (PZIR). Methods Recently diagnosed (<5 months) diabetic cats, treated with PLIS q12h for ⩾6 weeks, were recruited. Fructosamine, 24 h blood glucose curve (BGC), quality of life assessment (DIAQoL-pet score) and Diabetic Clinical Score (DCS) were assessed at enrolment (PLIS-treated) and 2, 4 and 12 weeks after transitioning to PZIR (starting dose 0.2-0.7 U/kg q12h). Short duration of insulin action was defined as <9 h. Linear mixed effects modelling assessed for change in fructosamine, mean blood glucose (MBG) during BGCs, DIAQoL-pet score, DCS and q12h insulin dose. McNemar's tests compared the proportion of cats with hypoglycaemia at week 0 (PLIS-treated) and week 4 (PZIR-treated). Results Twenty-two cats were recruited. Median PLIS dose at enrolment was 0.5 U/kg (interquartile range 0.3-0.7 U/kg) q12h, equalling median PZIR starting dose (0.5 U/kg; interquartile range 0.3-0.7 U/kg q12h). Transitioning was followed by significant decreases in fructosamine ( P = 0.00007), insulin dose ( P = 0.02), DCS ( P = 8.1 × 10-8) and DIAQoL-pet score ( P = 0.003), indicating improved quality of life. MBG did not alter significantly ( P = 0.1). Five cats (22.7%) achieved remission. Hypoglycaemia was recorded in 30/190 12 h BGCs (15.8%) and five cats experienced clinical hypoglycaemia. The proportion of cats with hypoglycaemia did not differ between PLIS (week 0) and PZIR (week 4) ( P = 1.0). Duration of action was analysed in 19 cats. Six cats (31.6%) showed short duration of action on PLIS, compared with two cats (10.5%) after 4 weeks on PZIR. All six cats with short PLIS duration showed duration of ⩾9 h on PZIR. Conclusions and relevance Used alongside a low-carbohydrate diet, transitioning to PZIR was associated with significantly improved clinical signs and quality of life, with some cats achieving remission. Transition to PZIR should be considered for cats with short duration of action on PLIS.

Juvenile Diabetes Mellitus and Concurrent Exocrine Pancreatic Insufficiency in a Labrador Retriever: Long-Term Management.

A 3 mo old, female, entire Labrador retriever presented with vomiting, diarrhea, polyuria, polydipsia, polyphagia, and stunted growth. Diagnostics revealed the presence of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency. Pancreatic histopathology showed severe pancreatic atrophy. Successful treatment was achieved with a combination of insulin and pancreatic enzymes. This report describes successful long-term treatment of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency in a dog.

Estudio observacional de eficacia y seguridad del cambio de insulina NPH a glargina en atención primaria. Estudio LAURA / An observational study of the efficacy and safety of insulin Glargine after switch from NPH insulin in Primary Care. The LAURA Study

OBJETIVO: Evaluar la eficacia y la seguridad del cambio de insulina NPH a insulina glargina en pacientes con diabetes mellitus tipo 2 (DM2) atendidos en atención primaria. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Cuarenta y seis médicos de atención primaria registraron la información clínica de pacientes tratados previamente con insulina NPH que cambiaron a glargina o siguieron con NPH a los 3-9 meses después de la visita de inclusión (diseño de inclusión glargina 2:NPH 1). RESULTADOS: Se analizaron 122 pacientes del grupo glargina y 57 del grupo NPH (edad 67,0 [± 9,8] años, 51,4% varones). Entre la visita inicial y la final se observaron reducciones de HbA1c de 1,07 (± 0,93)% vs 0,28 (± 0,67)% (p < 0,001), y de glucemia en ayunas de 38,4 (± 37,0) vs 15,7 (± 28,6) mg/dl (p < 0,001), entre ambos grupos. Se observó un control inadecuado (HbA1c ≥ 7%) en la visita final en el 61,3% vs 76,8% de los pacientes, respectivamente (p = 0,044). Los porcentajes de pacientes que experimentaron alguna hipoglucemia o hipoglucemias nocturnas durante el mes previo a la visita final fueron 6,6% vs 43,9% (p < 0,001) y 2,5% vs 21,1% (p < 0,001), respectivamente. Las variables asociadas a un buen control glucémico fueron unos valores basales de HbA1c y glucemia en ayunas más bajos, y el cambio a insulina glargina. El principal motivo para el cambio fue la ventaja de la inyección única diaria. CONCLUSIONES: Los pacientes con DM2 atendidos en atención primaria que cambian de insulina NPH a glargina presentan una mejora significativa del control glucémico y una menor frecuencia de hipoglucemias totales y nocturnas

OBJECTIVE: To assess the efficacy and safety of insulin Glargine in the Primary Care setting for patients with type 2 diabetes mellitus (DM2) previously treated with NPH insulin. MATERIAL AND METHODS: This was an observational retrospective study, with 46 participating Primary Care physicians, who recorded the clinical information of patients treated with NPH insulin and who switched to insulin Glargine or continued on NPH for 3-9 months (inclusion design 2 Glargine:1 NPH). RESULTS: A total of 122 patients in the Glargine group, and 57 patients in the NPH insulin group were evaluated; the patients had a mean age of 67.0 (9.8) years, and 51.4% were males. A difference in HbA1c reduction was seen when comparing the Glargine and NPH groups: 1.07 (0.93)% vs. 0.28 (0.67)%, respectively (P < 0.001); fasting plasma glucose reductions were 38.4 (37.0) mg/dl vs. 15.7 (28.6) mg/dl, respectively (P < 0.001). Inadequate control (HbA1c ≥ 7%) at final visit was noted in 61.3% vs. 76.8% of patients (P = 0.028), respectively. Total hypoglycemic and nocturnal hypoglycemic episodes within one month prior to final visit were 6.6% vs. 43.9%, and 2.5% vs. 21.1%, respectively (P < 0.001). The variables associated with better glycemic control were lower baseline HbA1c and fasting plasma glucose values, and the switch to Glargine. The main reason for change was the advantage of one injection a day. CONCLUSION: Patients with DM2 who are treated with NPH insulin in Primary Care and switch to Glargine show better glycemic control and experience fewer total and nocturnal hypoglycemic episodes

Management of cats on Lente insulin: tips and traps.

The majority of feline diabetic patients require insulin to stabilize their diabetes and lente insulins have been widely available for many years. Management of many cases using Lente insulins is straightforward and can produce an excellent quality and length of life.