Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Animal Diabetes Australia, Melbourne, Victoria, Australia.
J Small Anim Pract. 2022 Sep;63(9):645-660. doi: 10.1111/jsap.13507. Epub 2022 May 12.
Smarter understanding of diabetes pathophysiology and pharmacology of insulin therapy can lead to better clinical outcomes. Rather than looking for an insulin formulation that is considered "best" for a general population, it could be appropriate to seek the "smart" insulin choice, tailored to the specific clinical situation. Different treatment goals should be considered, with pros and cons to each. Ideally, insulin therapy in most diabetic dogs should mimic a "basal-bolus" pattern. The "intermediate"-acting insulin formulations might provide better "bolus" treatment in dogs than the rapid-acting formulations used in people. In patients with some residual beta cell function such as many diabetic cats, administering only a "basal" insulin might lead to complete normalisation of blood glucose concentrations. Insulin suspensions (neutral protamine Hagedorn, neutral protamine Hagedorn/regular mixes, lente and protamine zinc insulin) as well as insulin glargine U100 and detemir are "intermediate"-acting formulations that are administered twice daily. For a formulation to be an effective and safe "basal" insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
对糖尿病病理生理学和胰岛素治疗药理学有更深入的了解，可以带来更好的临床结果。与其寻找一种被认为对普通人群“最好”的胰岛素制剂，不如寻求“智能”胰岛素选择，根据具体的临床情况量身定制。不同的治疗目标应该被考虑，每种目标都有其优缺点。理想情况下，大多数糖尿病犬的胰岛素治疗应该模拟“基础-餐时”模式。与用于人类的速效制剂相比，中效胰岛素制剂可能为犬提供更好的“餐时”治疗。对于一些仍有β细胞功能的患者，如许多糖尿病猫，仅给予“基础”胰岛素可能导致血糖浓度完全正常化。胰岛素混悬剂（中性鱼精蛋白锌胰岛素、中性鱼精蛋白锌胰岛素/短效混合制剂、精蛋白锌胰岛素赖脯胰岛素和精蛋白锌胰岛素）以及甘精胰岛素 U100 和地特胰岛素都是每日两次给药的中效制剂。为了使一种制剂成为有效和安全的“基础”胰岛素，其作用在每天的每小时应该大致相同。目前，只有甘精胰岛素 U300 和德谷胰岛素在犬中符合这一标准，而在猫中，甘精胰岛素 U300 是最接近的选择。
