A dose titration protocol for once‐daily insulin glargine 300 U/mL for the treatment of diabetes mellitus in dogs

Abstract Background In purpose‐bred dogs, insulin glargine 300 U/mL (IGla300) has long duration of action, peakless time‐action profile, and low potency, making it suitable for use as a basal insulin. Hypothesis To evaluate IGla300 in client‐owned diabetic dogs monitored using a flash glucose monitoring system (FGMS). Animals Ninety‐five client‐owned diabetic dogs, newly diagnosed or previously treated with other insulin formulations, with or without concurrent diseases. Methods Prospective multi‐institutional study. Clinical signs and standardized assessment of FGMS data, using treatment and monitoring guidelines established a priori, guided dose adjustments and categorization into levels of glycemic control. Results The initial IGla300 dose was 0.5 U/Kg q24h for newly diagnosed dogs and (median dose [range]) 0.8 U/Kg (0.2‐2.5) q24h for all dogs. Glycemic control was classified as good or excellent in 87/95 (92%) dogs. The IGla300 was administered q24h (1.9 U/kg [0.2‐5.2]) and q12h (1.9 U/kg/day [0.6‐5.0]) in 56/95 (59%) and 39/95 (41%) dogs, respectively. Meal‐time bolus injections were added in 5 dogs (0.5 U/kg/injection [0.3‐1.0]). Clinical hypoglycemia occurred in 6/95 (6%) dogs. Dogs without concurrent diseases were more likely to receive IGla300 q24h than dogs with concurrent diseases (72% vs 50%, respectively; P = .04). Conclusions and Clinical Importance Insulin glargine 300 U/mL can be considered a suitable therapeutic option for once‐daily administration in diabetic dogs. Clinicians should be aware of the low potency and wide dose range of IGla300. In some dogs, twice‐daily administration with or without meal‐time bolus injections may be necessary to achieve glycemic control. Monitoring with FGMS is essential for dose titration of IGla300.