Update on insulin treatment for dogs and cats: insulin dosing pens and more

Figures & data

Table 1 Insulin types and pens

Type of insulin	Concentration	Brand name(s)	Manufacturer	Multi-use vials	Pen vials	Injection pens
						Disposable prefilled	Reusable
Veterinary insulin preparations
Insulin zinc suspension (lente)	40 U/mL	Vetsulin, Caninsulin	MSD Animal Health	2.5 mL and 10 mL	2.7 mL	None	VetPena,b
PZI	40 U/mL	ProZinc	Boehringer Ingelheim	10 mL	None	None	None
Traditionally available human insulin preparations
Regular insulin	100 (and 500) U/mL	Humulin R, Humulin S	Eli Lilly	3 mL and 10 mL (500 U/mL, 20 mL)	3 mL Humulin S	None	HumaPensa,b
Regular insulin	100 U/mL	ActRapid	Novo Nordisk	10 mL	3 mL	None	NovoPensa,b
Regular insulin	100 U/mL	Insuman Rapid	Sanofi Aventis	None	3 mL	None	Autopenb ClickSTARb ALLSTARb JuniorSTARa
NPH insulin	100 U/mL	Humulin N, Humulin I	Eli Lilly	10 mL and 3 mL	3 mL	Humulin N and Humulin I KwikPena	HumaPensa,b
NPH insulin	100 U/mL	Protophane	Novo Nordisk	10 mL	3 mL	Innoleta	NovoPensa,b
NPH insulin	100 U/mL	Insuman Basal	Sanofi Aventis	5 mL and 10 mL	3 mL	SoloSTARb	Autopenb ClickSTARb ALLSTARb JuniorSTARa
50% regular and 50% NPH	100 U/mL	Mixtard 50/50	Novo Nordisk	None	3 mL	Innoleta	NovoPensa,b
50% regular and 50% NPH	100 U/mL	Insuman Comb 50	Sanofi Aventis	None	3 mL	None	Autopenb ClickSTARb ALLSTARb JuniorSTARa
30% regular and 70% NPH	100 U/mL	Mixtard 30/70	Novo Nordisk	None	3 mL	Innoleta	NovoPensa,b
30% regular and 70% NPH	100 U/mL	Humulin 70/30; Humulin M3	Eli Lilly	10 mL and 3 mL	3 mL	Humulin 70/30; Humulin M3 KwikPenb	HumaPensa,b
25% regular and 75% NPH	100 U/mL	Insuman Comb 25	Sanofi Aventis	5 mL	3 mL	SoloSTARb	Autopenb ClickSTARb ALLSTARb JuniorSTARa
New human insulin preparations
Insulin lispro	100 U/mL	Humalog	Eli Lilly	3 mL and 10 mL	3 mL	Humalog KwikPenb	HumaPensa,b Autopenb
Insulin aspart	100 U/mL	NovoLog; NovoRapid	Novo Nordisk	10 mL	3 mL	NovoLog FlexPenb	NovoPensa,b
Insulin glulisine	100 U/mL	Apidra	Sanofi Aventis	10 mL	3 mL	Apidra SoloSTARb	Autopenb ClickSTARb ALLSTARb JuniorSTARa
50% lispro and 50% lispro protamine	100 U/mL	Humalog Mix 50/50	Eli Lilly	10 mL	None	Humalog Mix50 KwikPenb	None
30% aspart and 70% aspart protamine	100 U/mL	NovoLog Mix 70/30; NovoMix 30	Novo Nordisk	10 mL	3 mL NovoMix 30	NovoLog Mix 70/30 FlexPenb	NovoPena,b
25% lispro and 75% lispro protamine	100 U/mL	Humalog Mix 75/25	Eli Lilly	10 mL	None	Humalog Mix25 KwikPenb	None
Insulin glargine	100 U/mL	Lantus	Sanofi Aventis	10 mL	3 mL	Lantus SolarSTARb	Autopenb ClickSTARb ALLSTARb JuniorSTARa
Insulin glargine	100 U/mL	Abasria	Eli Lilly	None	3 mL	KwikPenb	HumaPensa,b
Insulin detemir	100 U/mL	Levemir	Novo Nordisk	10 mL	3 mL	Levemir FlexPenb Levemir FlexTouchb	NovoPensa,b
Insulin degludec	100 (and 200) U/mL	Tresiba	Novo Nordisk	3ml (100U/mL)	3mL	Tresiba FlexTouchbc	NovoPensb

Notes:

a 0.5 U increments;

b 1 U increments.

c 2 U increments. Availability of cartridges, insulin types, and pens will vary depending on country.

Abbreviations: NPH, isophane; PZI, protamine zinc insulin.

Table 2 Recommended starting doses of insulin for dogs and cats

Insulin type	Dose
Recommended starting doses of insulin for uncomplicated diabetic dogs
Lente	0.25–0.50 U/kg every 12 hours
NPH	0.25–0.50 U/kg every 12 hours
NPH mixes	0.25–0.50 U/kg every 12 hours
Recommended starting doses of insulin for dogs that do not respond to lente or NPH
Glargine	0.50 U/kg every 12 hours
rhPZI	0.50 U/kg every 12 hours
Detemir	0.10 U/kg every 12 hours
Recommended starting doses of insulin for diabetic cats
Glargine	0.25–0.50 U/kg every 12 hours
rhPZI	0.25–0.50 U/kg every 12 hours
Lente	0.25–0.50 U/kg every 12 hours
Detemir	0.25–0.50 U/kg every 12 hours

Note: Estimated ideal body weight rather than actual body weight should be used for thin or overweight animals.

Abbreviations: NPH, isophane; rhPZI, recombinant human protamine zinc insulin.

Figure 1 Innolet^® pen device with a large dose selector dial for people with impaired vision or dexterity (bottom) compared with a more standard pen (Lantus^®) device (top).

Figure 2 Example of a prefilled, disposable insulin dosing pen, the Lantus SoloStar^®.

Notes: (A) Pen with cap in place. (B) Pen with cap removed. (C) Close up of the dark gray dose selector dial and the purple release button at the end of the pen. (D) Pen tip with needles. (E) Pen tip with needle attached.

Figure 3 Examples of human pediatric reusable insulin dosing pens that can be loaded with 3 mL insulin cartridges and deliver doses in 0.5 U increments.

Notes: (A) HumaPen Luxura HD^® (Eli Lilly). (B) Close up of the silver dose selector dial and release button at the end of the HumaPen Luxura HD pen. (C) NovoPen 3 Demi^® (Novo Nordisk). (D) NovoPen 3 Demi with the cap removed and an insulin cartridge and needle in place.

Figure 4 VetPen^® for use with Vetsulin^®/Caninsulin^®.

Notes: (A) VetPen (MSD Animal Health). (B) VetPen with the cap removed and needle in place. (C) VetPen loaded with 2.7 mL insulin cartridges.

Figure 5 Air shot. One or two units of insulin are dialed and dispelled with the pen tip facing upward. This ensures that the pen is operating correctly and insulin, not air, is injected into the patient.

Figure 6 Cat sitting with minimal restraint for 5–10 seconds during simulated insulin administration.