A dose titration protocol for once-daily insulin glargine 300 U/mL for the treatment of diabetes mellitus in dogs

Abstract

Background: In purpose-bred dogs, insulin glargine 300 U/mL (IGla300) has long duration of action, peakless time-action profile, and low potency, making it suitable for use as a basal insulin.

Hypothesis: To evaluate IGla300 in client-owned diabetic dogs monitored using a flash glucose monitoring system (FGMS).

Animals: Ninety-five client-owned diabetic dogs, newly diagnosed or previously treated with other insulin formulations, with or without concurrent diseases.

Methods: Prospective multi-institutional study. Clinical signs and standardized assessment of FGMS data, using treatment and monitoring guidelines established a priori, guided dose adjustments and categorization into levels of glycemic control.

Results: The initial IGla300 dose was 0.5 U/Kg q24h for newly diagnosed dogs and (median dose [range]) 0.8 U/Kg (0.2-2.5) q24h for all dogs. Glycemic control was classified as good or excellent in 87/95 (92%) dogs. The IGla300 was administered q24h (1.9 U/kg [0.2-5.2]) and q12h (1.9 U/kg/day [0.6-5.0]) in 56/95 (59%) and 39/95 (41%) dogs, respectively. Meal-time bolus injections were added in 5 dogs (0.5 U/kg/injection [0.3-1.0]). Clinical hypoglycemia occurred in 6/95 (6%) dogs. Dogs without concurrent diseases were more likely to receive IGla300 q24h than dogs with concurrent diseases (72% vs 50%, respectively; P = .04).

Conclusions and clinical importance: Insulin glargine 300 U/mL can be considered a suitable therapeutic option for once-daily administration in diabetic dogs. Clinicians should be aware of the low potency and wide dose range of IGla300. In some dogs, twice-daily administration with or without meal-time bolus injections may be necessary to achieve glycemic control. Monitoring with FGMS is essential for dose titration of IGla300.

Keywords: FreeStyle Libre; Toujeo; basal‐bolus insulin therapy; continuous glucose monitoring; diabetic dogs.

FIGURE 1

Comparison of insulin administration frequency between dogs with concurrent diseases (n = 54) and those without (n = 36). Dogs receiving meal‐time bolus injections (n = 5) were excluded from the statistical analysis. Data are presented as frequencies.

FIGURE 2

Box plots of the total insulin dose in dogs with (n = 57) or without (n = 38) concurrent diseases. The vertical bars in the middle of the box represent the median value.