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A pilot study comparing a protocol using intermittent administration of glargine and regular insulin to a continuous rate infusion of regular insulin in cats with naturally occurring diabetic ketoacidosis

Gallagher, Brandi R., Mahony, Orla M., Rozanski, Elizabeth A., Buob, Sibylle, Freeman, Lisa M.
Journal of veterinary emergency and critical care 2015 v.25 no.2 pp. 234-239
appetite, bicarbonates, cats, hyperglycemia, insulin, ketonemia, ketosis, pH, randomized clinical trials, veterinary medicine
OBJECTIVE: The goal of this pilot study was to compare regular insulin administered by continuous rate infusion (CRI) to an approach using insulin glargine and regular insulin administered intermittently. DESIGN: Prospective randomized clinical trial. SETTING: University teaching hospital. ANIMALS: Sixteen cats with diabetic ketoacidosis (DKA). INTERVENTIONS: Cats with DKA were randomized to either low‐dose regular insulin CRI (CRI group; n = 8) or intermittent short‐ and long‐acting insulin injections (subcutaneous [SC] glargine plus intramuscular [IM] regular insulin; SC/IM group; n = 8). MEASUREMENTS AND MAIN RESULTS: Time of normalization of pH, bicarbonate, hyperglycemia, ketonemia, and appetite, as well as duration of hospitalization were recorded. Eleven of 16 cats (59%) survived to discharge, with no difference in survival between groups (P = 0.99). Times of resolution of hyperglycemia (P = 0.02) and ketonemia (P = 0.04), and normalization of pH (P = 0.04), and bicarbonate (P = 0.03) were significantly shorter in the SC/IM group. Cats in the SC/IM group also had a significantly shorter duration of hospitalization (SC/IM: median = 54 hr [range, 19–118 hr]; CRI: median = 111 hr [range, 58–271 hr]; P = 0.04). Time of first meal was not significantly different between groups. CONCLUSIONS: Although further research is required, an approach using intermittent short‐ and long‐acting insulin injections appeared to be an effective option for treatment of DKA in cats.