Lispro insulin and electrolyte supplementation for treatment of diabetic ketoacidosis in cats

Abstract

Background Intravenous continuous rate infusion (IVCRI) of lispro at a starting dose of 0.09 U/kg/h and the use of 0.9% sodium chloride (NaCl) for fluid resuscitation in cats with diabetic ketoacidosis (DKA) have not been reported. Protocols for correction of electrolyte deficiencies in cats with DKA are lacking. Objectives To characterize the use of IVCRI lispro at an initial dose of 0.09 U/kg/h and the use of NaCl for resuscitation. Explore protocols for electrolyte supplementation in cats with DKA. Animals Twelve cats with DKA enrolled from the cat population of a university hospital. Methods Randomized, controlled, blinded study. Six cats were randomized into each group, the lispro insulin treatment group (LITG) and regular insulin treatment group (RITG). All cats received IVCRI fluid resuscitation with NaCl. Solutions with higher than previously published electrolyte concentrations were used to treat electrolyte deficiencies. Results The median time to blood glucose (BG) concentration <250 mg/dL was significantly shorter in the LITG (median 7 hours, 2‐10 hours) than the RITG (median 12.5 hours, 8‐20 hours; P = .02). Two cats had nonclinical hypoglycemia (BG = 40 mg/dL). The most rapid change in 157 measurements of corrected sodium concentrations was 0.7 mmol/L/h. Low concentrations of serum sodium, potassium, phosphate, and magnesium were over 3 times more common than above normal electrolyte concentrations, despite supplementation with fluids of high electrolyte concentrations. Conclusions and Clinical Importance Lispro at a starting dose of 0.09 U/kg/h and NaCl administered for fluid resuscitation are safe and effective for treatment of DKA in cats.

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

“…The median time for resolution of ketonemia in our CRI‐group was 42 hours, compared to 62 and 68 hours in 2 previous studies 1,5 . A possible explanation is the use of a different protocol for adjustment of insulin and glucose administration.…”

“…54 An earlier study demonstrated that 0.9% saline was effective and safe for volume resuscitation and maintenance fluid therapy in ketoacidotic cats. 1 To avoid adverse events associated with hypophosphatemia such as hemolytic anemia, IV phosphorus supplementation (potassiumphosphate) was a fixed part of our treatment protocol. Severe depletion of phosphorus may lead to ATP depletion in erythrocytes, causing failure of actin and myosin fibers in the cell membranes to maintain normal biconcave structure and deformability.…”

“…Diabetic ketoacidosis (DKA) is an acute, life‐threatening metabolic complication of feline diabetes mellitus (DM), and mortality rates range from 17 to 50% 1–6 . Despite this, studies are scarce, and current treatment recommendations are mostly extrapolated from experiences in people and dogs.…”

Efficacy and Safety of Intramuscular Insulin Lispro vs. Continuous Intravenous Regular Insulin for the Treatment of Dogs With Diabetic Ketoacidosis

“…In veterinary medicine, the use of rapid-acting analogs has been evaluated in dogs and cats with DKA, but only using protocols based on IVCRI (22)(23)(24)(25). To the authors' knowledge, the use of rapid-acting analogs via other route of administration for the treatment of dogs with DKA has not yet been investigated.…”

“…Four studies have demonstrated that IV continuous rate infusion (IVCRI) of insulin lispro or aspart is safe and appears to be as effective as an IVCRI of regular insulin for the treatment of canine and feline DKA (22)(23)(24)(25). However, the limitation of these studies was the use of the IV route of administration, not taking advantage of the qualities deriving from the molecular structure which characterizes insulin analogs.…”