Detemir Dose Adjustments in Small Breed Dogs

I need some advise about how to make dose adjustments when using insulin detemir (Levemir, Novo Nordisk) in small dogs. I know this is a very potent insulin in dogs (1,2), so I start all of the dogs on only 0.1 U/kg, BID. Therefore, many of these dogs are receiving only 0.5 to 1.0 units, twice a day.

If their clinical signs of diabetes persist and serial glucose curves indicate poor blood glycemic control, (or an inadequate insulin dose), how do you increase the detemir dosage?

In other words, how much of an increase in daily dosage would be too much? Because detemir is a very potent insulin in dogs, I am trying to be really cautious because I don't want to cause an overdose leading to hypoglycemia.

My Response:

As a general rule, if a small dog is on 0.5 units twice a day and the dose needs to be increased, it is safe to raise the detemir dose to 1.0 U, BID (3). If further dose increases are needed in small breed dogs, it's safest to continue to go up by only 0.5 U increments.

In larger dogs (>15 kg), we generally can increase by 1-unit increments. So if a 20 kg dog was started on 2 U of detemir, BID and needed the dose increased, I'd go up to 3 U, BID.

Whenever I make dose adjustment, no matter how large the dog, I wait 1 week or so and then repeat the serial glucose curve to make any additional needed dose adjustments.

Usually after a few curves, we can get a feeling for how sensitive an individual dog is to dose changes with the insulin detemir, so then it gets easier to decide by how much to adjust the insulin dose.

References:

1. Sako T, Mori A, Lee P, et al. Time-action profiles of insulin detemir in normal and diabetic dogs. Research in Veterinary Science 2011;90:396-403. 
2. Gilor C, Graves TK. Synthetic insulin analogs and their use in dogs and cats. Veterinary Clinics of North America Small Animal Practice 2010;40:297-307. 
3. Ford SL, Rand JS, Ghormley et al. Evaluation of detemir insulin in diabetic dogs managed with blood glucose monitoring. In: ACVIM Forum, Annual Conference of the American College of Veterinary Internal Medicine, 2010.