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CENTRE FOR COMPANION ANIMAL HEALTH
The School of Veterinary Science, The University of Queensland
ww.uq.edu.au/ccah; +617 3365 2122
Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose
concentrations to adjust insulin dose
Roomp K, RAND JS Evaluation of intensive blood glucose control using glargine in diabetic cats. Vet Intern Med 2008; 22 (3):770; Roomp K, RAND JS Factors predictive of non-insulin dependence in diabetic cats initially treated with insulin. Vet Intern Med 2008; 22 (3):791; and Roomp and Rand, unpublished data Table 3A. Parameters for changing insulin dosage when using insulin glargine (Lantus) or detemir (Levemir) together with home monitoring of blood glucose concentrations in a protocol aimed at
achieving intensive blood glucose control. Blood glucose should be measured at least 3 times daily with a
glucometer. This protocol was tested in 55 diabetic cats for glargine and 18 diabetic cats for detemir. Owners
measured blood glucose an average of 5 times daily and adjusted insulin dose based on the protocol. This
has not been tested with veterinarian-measured blood glucose curves once every week or two weeks, and
Table 2 is recommended if intensive home monitoring is not being performed.
NB. The blood glucose values were based on using portable glucose meters (Ascensia Contour, Bayer, Leverkusen, Germany; Accu-Chek Aviva, Roche Diagnostics, Basel, Switzerland) which use ≤0.6 µL of
blood per test. These meters measure blood glucose concentration in whole blood and are calibrated for
use with human blood.
Measurements from meters calibrated for human blood which provide plasma-
equivalent values are approximately 10% higher.
NB. It is very important to note that blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than
glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated
for feline use. Therefore, if using a meter calibrated for feline use (eg. AlphaTRAK, Abbott
Laboratories, CA, USA), or a serum chemistry analyzer,
add approximately 30 mg/dL (1.7 mmol/L)
to the target glucose concentrations (see Table 3B). For example, a target > 50 mg/dL (2.8
mmol/L) becomes > 80 mg/dL (4.4 mmo/L) when using a meter calibrated for feline use. Instead of
aiming for 50-100mg/dL (2.8-5.6 mmol/L) , aim for 80-130 mg/dL (4.4-7.2 mmol/L [round numbers
4.5-7.0 mmol/L). Meters calibrated for feline use may read higher or lower than the actual value, in
contrast to consistently lower readings for meters validated for human blood.

NB Mean median maximum dose in cats on detemir is about 30% less than for glargine (1.7 U/cat BID; range 0.5 to 4.0 IU versus 2.5 U/cat BID; range 1.0 to 9.0 IU BID). CENTRE FOR COMPANION ANIMAL HEALTH
The School of Veterinary Science, The University of Queensland
ww.uq.edu.au/ccah; +617 3365 2122
TABLE 3A: Target blood glucose concentrations when using a blood glucose meter
calibrated for human blood which measures glucose concentrations in whole blood. DO
NOT USE THESE TARGET GLUCOSE CONCENTRATIONS IF USING A METER
CALIBRATED FOR FELINE USE
(eg. Abbott AlphaTRAK) or a serum chemistry analyzer – use
table 3B instead)
.
Dose increases are per injection per cat. Parameter used for dosage adjustment
Change in dose
Phase 1: Initial dose and first 3 days on glargine or detemir
Begin with 0.25 IU/kg of ideal weight BID OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
Cats with a history of developing ketones that remain >300
mg/dL (17 mmol/L) after 24-48 hours If blood glucose is < 50 mg/dL (2.8 mmol/L) Reduce dose by 0.25-0.5 IU depending on if cat on low (<3 IU/cat) or high dose (≥ 3 IU/cat) of insulin Phase 2: Increasing the dose
If nadir blood glucose concentration >300mg/dL (17 mmol/L) If nadir blood glucose concentration 200-300mg/dL (11-17 Increase every 3 days by 0.25-0.5 IU depending on if If nadir blood glucose concentration < 200mg/dL but peak is > Increase every 5-7 days by 0.25-0.5 IU depending on If blood glucose is < 50 mg/dL (2.8 mmol/L) Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin If blood glucose at the time of the next insulin injection 50-100 Initially test which of the alternate methods is best suited to the individual cat:
a. Feed cat and reduce the dose by 0.25-0.5 IU
depending on if cat on low or high dose of insulin
b. Feed the cat, wait 1-2 hours and when the glucose
concentration increases to >100 mg/dL give the
normal dose. If the glucose concentration does not
increase within 1-2 hours, reduce the dose by 0.25 IU
or 0.5 IU (as above).
c. Split the dose: feed cat, and give most of dose
immediately and then give the remainder 1 to 2 hours
later, when the glucose concentration has increased
to >100 mg/dL.
If all these methods lead to increased blood glucose
concentrations, give the full dose if pre-insulin blood
glucose concentration is 50-100 mg/dL and observe
closely for signs of hypoglycemia. In general for
most cats, the best results in phase 2 occur when
insulin dose is as consistent as possible, giving the
full normal dose at the regular injection time.
CENTRE FOR COMPANION ANIMAL HEALTH
The School of Veterinary Science, The University of Queensland
ww.uq.edu.au/ccah; +617 3365 2122
Phase 3: Holding the dose. Aim to keep blood glucose
concentration within 50-200 mg/dL (2.8 – 11 mmol/L)
throughout the day.

If blood glucose is < 50 mg/dL (<2.8 mmol/L)
Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin If nadir or peak blood glucose concentration > 200mg/dL (11 Increase dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin and the degree of hyperglycemia Phase 4: Reducing the dose. Phase out insulin slowly by 0.25-
0.5U depending on dose.
When the cat regularly (every day for at least one week), has its
Reduce dose by 0.25-0.5 IU depending on if cat on lowest blood glucose concentration in the normal range of a healthy cat, and stays under 100 mg/dL overall If the nadir glucose concentration is 40 - <50 mg/dL (2.2-<2.8 Reduce dose by 0.25-0.5 IU depending on if cat on mmol/L) at least three times on separate days If the cat drops below 40 mg/dL once (2.2 mmol/L) Reduce dose immediately by 0.25-0.5 IU depending on if cat on low or high dose of insulin If peak blood glucose concentration > 200mg/dL (11 mmol/L) Immediately increase insulin dose to last effective dose Phase 5: Remission. Euglycemia for a minimum of 14 days
without insulin.
CENTRE FOR COMPANION ANIMAL HEALTH
The School of Veterinary Science, The University of Queensland
ww.uq.edu.au/ccah; +617 3365 2122

TABLE 3B: Target blood glucose concentrations when using a blood glucose meter calibrated
for feline use (eg. AlphaTRAK Abbott Laboratories).
Dose increases are per injection per cat. NB Mean median maximum dose in cats on detemir is about 30% less than for glargine (1.7 U/cat BID; range 0.5 to 4.0 IU versus 2.5 U/cat BID; range 1.0 to 9.0 IU BID). Parameter used for dosage adjustment
Change in dose
Phase 1: Initial dose and first 3 days on glargine or detemir
Begin with 0.25 IU/kg of ideal weight BID OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
Cats with a history of developing ketones that remain >300
mg/dL (after 24-48 hours If blood glucose is < 80 mg/dL (4.5 mmol/L) Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin Phase 2: Increasing the dose
If nadir blood glucose concentration >300mg/dL (17 mmol/L) If nadir blood glucose concentration 200-300mg/dL (11-17 Increase every 3 days by 0.25-0.5 IU depending on if cat on a low (<3 IU/cat) or high dose (≥ 3 IU/cat) of insulin If nadir blood glucose concentration < 200mg/dL but peak is > Increase every 5-7 days by 0.25-0.5 IU depending on If blood glucose is < 80 mg/dL (4.5 mmol/L) Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin If blood glucose at the time of the next insulin injection 80-130 Initially test which of the alternate methods is best suited to the individual cat:
a. Feed cat and reduce the dose by 0.25-0.5 IU
depending on if cat on low or high dose of insulin
b. Feed the cat, wait 1-2 hours and when the glucose
concentration increases to >100 mg/dL give the
normal dose. If the glucose concentration does not
increase within 1-2 hours, reduce the dose by 0.25 IU
or 0.5 IU (as above).
c. Split the dose: feed cat, and give most of dose
immediately and then give the remainder 1 to 2 hours
later, when the glucose concentration has increased
to >100 mg/dL.
If all these methods lead to increased blood glucose
concentrations, give the full dose if pre-insulin blood
glucose concentration is 50-100 mg/dL and observe
closely for signs of hypoglycemia. In general for
most cats, the best results in phase 2 occur when
insulin dose is as consistent as possible, giving the
full normal dose at the regular injection time.
CENTRE FOR COMPANION ANIMAL HEALTH
The School of Veterinary Science, The University of Queensland
ww.uq.edu.au/ccah; +617 3365 2122
Phase 3: Holding the dose. Aim to keep blood glucose
concentration within 80-200 mg/dL (4.5 – 11 mmol/L)
throughout the day.

If blood glucose is < 80 mg/dL (<4.5 mmol/L)
Reduce dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin If nadir or peak blood glucose concentration > 200mg/dL (> 11 Increase dose by 0.25-0.5 IU depending on if cat on low or high dose of insulin and the degree of hyperglycemia Phase 4: Reducing the dose. Phase out insulin slowly by 0.25-
0.5U depending on dose.
When the cat regularly (every day for at least one week), has its
Reduce dose by 0.25-0.5 IU depending on if cat on lowest blood glucose concentration in the normal range of a healthy cat, and stays under 130 mg/dL (7.2 mmol/L) overall If the nadir glucose concentration is 70 - <80 mg/dL at least Reduce dose by 0.25-0.5 IU depending on if cat on three times on separate days (3.9-<4.5 mmol/L) If the cat drops below 70 mg/dL once (4.5 mmol/L) Reduce dose immediately by 0.25-0.5 IU depending on if cat on low or high dose of insulin If peak blood glucose concentration > 200mg/dL (>11 mmol/L) Immediately increase insulin dose to last effective dose Phase 5: Remission. Euglycemia for a minimum of 14 days
without insulin.

Source: http://www.felinediabetes.com/Roomp_Rand_2008%20dosing_testing%20protocol.pdf

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