Pet Diabetes Awareness and Prevention Program
by Defeat Diabetes Foundation
Insulin and How to Administer Properly
Types of insulin and insulin analogs
The source of insulin used in insulin preparations can vary. Some preparations contain porcine insulin. Recombinant human insulins are also available. Insulin analogs (or insulin receptor ligands) are synthetic analogs of insulin created by genetic engineering which perform the same actions as insulin in the body.
Insulin preparations can be divided into three categories:
- Long-acting insulins and insulin analogs
- Ultralente insulins - 100% crystalline insulin
- PZI insulins - contain protamine and zinc
- Insulin glargine and insulin detemir are insulin analogs that are released slowly over a period of up to 24 hours (in humans) and intended to supply a basal level of insulin.
- Intermediate-acting insulins
- Lente insulins - mixtures of 30% amorphous (semilente) and 70% crystalline (ultralente) insulin in an aqueous suspension.
- NPH insulins - contain protamine
- Rapid-acting insulins and insulin analogs
- Soluble insulin and semilente insulin: intravenous administration possible
- Insulin lispro, insulin aspart and insulin glulisine are insulin analogs that readily absorbed from the injection site which are used to provide a bolus of insulin for after a meal (in humans)
Due to differences in metabolism, the duration of activity of any particular insulin will vary from animal to animal.
Insulin formulated for veterinary use has a strength of 40 IU/ml meaning small dose volumes can be measured fairly easily and accurately. Human insulin preparations have a strength of 100 IU/ml. Special 40 IU/ml syringes are available for accurate measurement of insulin doses. Insulin is available in 2.5 ml or 10 ml vials taking all sizes of pets into consideration.
Porcine insulin zinc suspension - Intermediate acting insulin for the treatment of diabetes in dogs and cats
Dietary control and daily agents used for treating diabetes in people have not been effective in dogs, but research is continuing in this area.
Insulin requirements cannot be predicted solely on the basis of the dog’s weight, because the degree of pancreatic failure is different in every dog. The daily insulin dose must be established for each individual. In the newly diagnosed diabetic, insulin therapy is started at home. After a week of treatment, the dog is brought back to the clinic and a blood glucose curve (a series of blood sugar tests drawn over 12 to 24 hours) is obtained to see when the blood glucose peaks and hits its lows. Refinements are then made in the dosage and timing of the injections. How to prepare and inject the insulin will be explained to you by your veterinarian. You may be asked to monitor urine glucose levels by collecting urine samples and using a test strip (a small piece of paper that indicates the glucose levels in urine).
Most diabetic cats require insulin injections administered under their skin twice daily. The injections can be given at home, preferably at the same time each day. Your veterinarian will show you how to give these injections, which are not painful—in fact, most cats are unaware that the injection is being given. Because each is different, the proper type of insulin, dose, and frequency of administration needs to be determined by your veterinarian. Ideally, this is based on an 18- to 24-hour blood glucose profile, obtained through a veterinarian-administered insulin injection and subsequent testing of blood sugar levels at regular intervals throughout the day. Insulin dosage may change with time and may need to be adjusted based on new blood glucose profiles, the results of intermittent blood tests and urine sugar measurements, and the cat's response to therapy.
Improper handling or administration of insulin is one of the most common reasons why some dogs seem difficult to regulate. Below is a list of helpful hints. Coming soon we will have a video showing proper administration technique.
Keep insulin refrigerated except when in use. The vial should be stored in a cooler with an ice pack when traveling, even for just a few hours.
Use syringes which match the concentration of insulin used.
To mix insulin, gently roll the vial between the palms of your hands until well mixed. DO NOT SHAKE OR ROUGHLY AGITATE THE VIAL under any circumstances; this breaks apart the
insulin molecules and may render the insulin ineffective or at best unpredictable in its activity.
Insert the needle into the rubber port of the insulin vial while the mixed vial is held inverted. Withdraw gently, applying constant, even suction until a volume greater than the actual dose required is aspirated into the syringe. Still maintaining the vial in its inverted position, depress plunger of syringe to expel any bubbles or excess insulin back into the vial until the proper dose remains in the syringe. If large bubbles are present in the syringe, depress the plunger and evacuate the contents gently back into the vial and re-initiate withdrawal as above, but being more gentle and aspirating more than previously. DO NOT RIGOROUSLY AGITATE OR CONCUSS THE SYRINGE (Coming soon - a hyperlink to video clip #2) IN AN EFFORT TO MAKE BUBBLES “RISE TO THE TOP” TO EVACUATE. Instead, a very gentle tap may be sufficient. If not, depress the contents of the syringe back into the vial and begin again. It is not essential to evacuate every tiny bubble, particularly if the dose is greater than 10 units.
Keep in mind that it may be easier and more accurate to administer smaller doses (<10 units) in smaller volume syringes such as 1/4 cc (for 25 units or less), 1/3 cc (for 30 units or less) or 1/2 cc (for 50 units or less) syringes. It is well documented, in fact, that marked overdoses occur when small doses (<5 units) are administered with 1 cc U-100 syringes.
The volume of insulin drawn up should be measured from where the rubber part of the plunger contacts the insulin, not the other side where the rubber is attached to the rest of the plunger.
When treating the newly diagnosed diabetic pet, it is helpful to ask your veterinarian to shave several small spots over the back so that you can actually see the needle enter the skin. This prevents “intra-fur” or in-the-fur injections that often occur when first learning how to administer insulin. It is also helpful to lift, or “tent” the skin up and inject at an angle almost parallel to the backbone into the small triangle formed by the “tent”. It is not unusual to penetrate one side of the tented skin and go right through and out the other side of the skin, causing another “intra-fur” injection that will obviously not control blood sugar levels. Penetrating the skin more toward the base of the “tent” will help to insure that the tip of the needle is under, and not through the skin on the other side.
Proper Injection Technique Picture Below
Improper Injection Technique
Types of Syringes
Always use a U-40 insulin syringe with U-40 insulin and a U-100 insulin syringe with U-100 insulin.
0.3 and 0.5 mL insulin syringes are best to facilitate accurate dosing, especially in cats and dogs getting <5 U per dose.
Syringes are for single use.
Do not use "short" needles. A standard 29-g, half-inch length needle is recommended.
We hope the following information will help you either prevent diabetes, diagnose diabetes or take care of your pet that may have diabetes:
Testing and Supplies
The information presented in this website are not intended to replace the services of a health practitioner licensed in the diagnosis or treatment of illness or disease. Any application of the material herein is at the reader's discretion and sole responsibility. If your pet has a persistent medical condition or the symptoms are severe, please consult a veterinarian.
Updated: May 14, 2013