‘Second-line’ insulins for dogs
I think there’s little doubt that using the only licensed product as first-line therapy is the way to go. However, there are some dogs whose control isn’t great on Caninsulin and the most common issue in my experience is insufficient duration of effect with twice daily dosing.
For some time my second-line option in this situation has been insulin detemir (Levemir) -which is very effective in some dogs. However, this choice was largely based on anecdotal evidence and I’ve been forced to review this decision in the light of recent publications.
Fracassi and others…
http://www.ncbi.nlm.nih.gov/pubmed/26086231
…looked at 10 dogs managed with twice daily detemir. That’s still a very small study but better than nothing. To simplify grossly, control was pretty good in most dogs BUT 4/10 suffered clinically-significant hypoglycaemic episodes. Detemir appears to be very potent in dogs and the volumes required are very small -especially in dogs below 10Kg.
Furthermore, on the very limited available evidence, insulin glargine looks similarly-effective….
http://www.ncbi.nlm.nih.gov/pubmed/24094263
…and probably carries lower risk. The dogs on this study were also fed a high fibre diet.
A very useful and more extensive review can be found here:
