Lispro insulin and electrolyte supplementation for treatment of diabetic ketoacidosis in cats

Abstract

Background: Intravenous continuous rate infusion (IVCRI) of lispro at a starting dose of 0.09 U/kg/h and the use of 0.9% sodium chloride (NaCl) for fluid resuscitation in cats with diabetic ketoacidosis (DKA) have not been reported. Protocols for correction of electrolyte deficiencies in cats with DKA are lacking. Objectives: To characterize the use of IVCRI lispro at an initial dose of 0.09 U/kg/h and the use of NaCl for resuscitation. Explore protocols for electrolyte supplementation in cats with DKA. Animals: Twelve cats with DKA enrolled from the cat population of a university hospital. Methods: Randomized, controlled, blinded study. Six cats were randomized into each group, the lispro insulin treatment group (LITG) and regular insulin treatment group (RITG). All cats received IVCRI fluid resuscitation with NaCl. Solutions with higher than previously published electrolyte concentrations were used to treat electrolyte deficiencies. Results: The median time to blood glucose (BG) concentration <250 mg/dL was significantly shorter in the LITG (median 7 hours, 2-10 hours) than the RITG (median 12.5 hours, 8-20 hours; P =.02). Two cats had nonclinical hypoglycemia (BG = 40 mg/dL). The most rapid change in 157 measurements of corrected sodium concentrations was 0.7 mmol/L/h. Low concentrations of serum sodium, potassium, phosphate, and magnesium were over 3 times more common than above normal electrolyte concentrations, despite supplementation with fluids of high electrolyte concentrations. Conclusions and Clinical Importance: Lispro at a starting dose of 0.09 U/kg/h and NaCl administered for fluid resuscitation are safe and effective for treatment of DKA in cats.