title: 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).
abstract: 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.
  
  
  METHODS
  Retrospective study (January 1, 2003-March 1, 2013).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Sixty dogs and cats with DK or DKA receiving short-acting insulin therapy.
  
  
  METHODS
  None.
  
  
  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 short-acting 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.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853.
authors.forename: Jillian
authors.initials: J
authors.lastname: DiFazio
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Fletcher
mesh_terms: D000818:Animals; D001786:Blood Glucose; D002371:Cat Diseases / Q000188:drug therapy*; D002415:Cats; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000662:veterinary*; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004333:Drug Administration Routes; D015994:Incidence; D007275:Injections, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D007662:Ketosis; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: DKA; glucosuria; hyperglycemia; ketonemia; ketonuria; metabolic acidosis