Insulin Alternatives

CONTROLLING DIABETES MELLITUS WITHOUT INSULIN

In people, diabetes is readily classified into Type I and Type II forms.  The Type I human diabetic has no capacity for insulin secretion at all and is totally insulin dependent. The Type II diabetic develops diabetes later in life and simply has an inadequate (ie only partial) capacity for insulin secretion.  Since insulin injections are unpopular among people, there is a demand for oral products to control blood sugar. Unfortunately, there is just no substitute for insulin but when there is simply not enough insulin, oral products have a place, making what insulin there is work better.

Insulin injections are similarly unpopular among the owners of diabetic pets and there is demand for an oral solution in the veterinary market. Unfortunately, non-human diabetes is not so readily classified as Type I and Type II nor have the human oral products been widely used/tested in pets. Still, there is some information available and we hope to summarize it.

ORAL AGENTS IN THE CAT

It seems that many cats experience a diabetes that is analogous to human Type II  diabetes; that is, these cats are still able to produce at least some insulin. These patients, though there is no way to identify them except by medication trial, may respond to medications given orally. In many cases, the benefit of an oral treatment is to improve the effectiveness of the insulin treatment.

    GLIPIZIDE (GLUCOTROL®)

    Glipizide acts by increasing the pancreas’ secretion of insulin and it is possible that a level of adequate control can be achieved by maximizing the pancreas’ secretion in this way.  There is some capacity for side effects (15% of cats taking this medication will get an upset stomach) plus the majority of cats will not be controlled with this medication alone.  Glipizide is often used as a last resort (ie when it is not possible to give insulin injections) as in increasing the pancreas’ insulin secretion, it also increases the pancreas’ amyloid build up (which is what probably caused the diabetes in the first place).  For more complete information on this medication click here.

    Similar medications are Glyburide (Dia-B®) and glibenclamide (Daonil®). These were developed as human alternatives to glipizide and have less side effect potential in humans. There are no published reports on their use in cats.

    METFORMIN (DIABEX®, GLUCOPHAGE®, DIAFORMIN®)

    This medication acts by increasing tissue sensitivity to insulin (ie it makes insulin stronger). Feline studies are in progress but look promising for cats as a supplement to insulin treatment.

    VANADIUM

    This is a trace mineral present virtually everywhere. It seems to have insulin-like properties and minimal side effects potential but is not likely to be helpful by itself. The form that has been studied was vanadium dipicolinate which is not commercially available. The vitamin stores sell vanadium sulfate (vanadyl fuel®) but we do not know if it works as well as the dipicolinate form did in the research setting.

    ACARBOSE (GLUCOBAY®, PRECOSE®)

    This medication inhibits the digestive enzymes responsible for breaking down starches. It’s use leads to a more gradual absorption of sugars after a meal which in turn leads to a more stable blood sugar level.  This medication is expensive and has potential for side effects (flatulence, weight loss, and diarrhea) and there are no published reports suggesting it works in cats.

    THE ONLY TRUE ORAL ALTERNATIVE TO INSULIN
    WHICH MIGHT WORK IN THE CAT IS GLIPIZIDE.

ORAL AGENTS IN THE DOG

The canine diabetes mellitus experience is more readily compared to Type I (insulin dependent) diabetes in humans. Drugs that are often helpful for feline diabetics have been crashing failures in dogs when used alone; however, some agents can be used as adjuncts to assist the insulin in achieving normal blood sugar levels.

    ACARBOSE (GLUCOBAY®, PRECOSE®)

    This medication inhibits the digestive enzymes responsible for breaking down starches. It’s use leads to a more gradual absorption of sugars after a meal which in turn leads to a more stable blood sugar level.  This medication is expensive and has potential for side effects (flatulence, weight loss, and diarrhea) thus it is not used except in dogs that have been difficult to control with insulin alone.

    CHROMIUM PICOLINATE

    This product is a mineral supplement that can be found in many vitamin stores. In normal dogs, it seems to potentiate the effects of insulin (ie the insulin becomes stronger).  This effect has not been found in diabetic dogs, however.

DIETARY THERAPY

It is important not to omit the obvious when looking at non-insulin therapies for diabetes mellitus. Traditionally the prescription high fiber diets have been helpful in managing diabetes mellitus. Fiber slows the absorption of dietary sugars, helps control obesity (a common diabetic problem), and somehow seems to help the body’s tissues respond more effectively to insulin. There are a number of appropriate diets available through veterinary offices.

Obviously, it is crucial that the diabetic pet continues to eat. If the pet does not like the new food, do not attempt to starve the pet into eating the new food. Inform your veterinarian that you are having trouble so that appropriate recommendations can be made.

Some recent studies have supported higher protein diets for diabetic cats. This is an area where new research may revise traditional thinking. We will update this area as more detail becomes available.