Retrospective comparison of early-versus late-insulin therapy regarding effect on time to resolution of diabetic ketosis and ketoacidosis in dogs and cats: 60 cases (2003-2013)

Objective - To determine whether early insulin administration (<= 6 h after admission) results in more rapid resolution of diabetic ketosis (DK) and ketoacidosis (DKA), shorter duration of hospitalization, and higher incidence of complications, and whether more severe ketonuria is associated with longer time to resolution of DK/DKA. Design - Retrospective study (January 1, 2003-March 1, 2013). Setting - University teaching hospital. Animals - Sixty dogs and cats with DK or DKA receiving short-acting insulin therapy. Interventions - None. Measurements and Main Results - Medical records were reviewed and data recorded including signalment; previous history of diabetes; intake temperature, blood pressure, blood glucose, pH, base excess, and degree of ketonuria; time to short-acting insulin therapy and resolution of DK/DKA; length of hospitalization; and complications. Insulin was initiated <= 6 hours in the early group and >6 hours in the late group after hospital admission. Early group patients had more rapid resolution of DK/DKA after starting short-acting insulin therapy (36.4 +/- 22.6 vs. 55.4 +/- 26.6 h, P = 0.014). There was no difference in duration of hospitalization or complications. More severe ketonuria resulted in longer time to resolution of DK/DKA after initiation of shortacting insulin (severe: 50.9 +/- 24.2; moderate: 29.6 +/- 19; mild: 23.4 +/- 21.9 h, P = 0.005, all individual pairwise comparisons P < 0.05). Conclusions - Early insulin administration is associated with more rapid resolution of DK/DKA without an associated increase in complication rates. DK/DKA took longer to resolve with more severe ketonuria. Prospective studies are warranted to identify specific time targets for insulin administration in DK/DKA patients.