Factors influencing insulin prescribing practices among small animal specialists

Initial management of diabetic ketoacidosis (DKA) often involves administration of regular insulin, and the transition from regular to intermediate or long-acting insulin can be challenging. While some guidelines exist for this, recent developments in the field have altered the diabetes treatment landscape. The objective of this study was to describe insulin prescribing practices of small animal specialists for patients with DKA and to explore the factors influencing the selection of insulin type and dose. An electronic survey involving two clinical case scenarios was distributed to diplomates of American College of Veterinary Internal Medicine (ACVIM) and American College of Veterinary Emergency and Critical Care (ACVECC) in Spring 2025. For the canine case, 76/162 participants (47%) selected insulin lente (Vetsulin^® or Caninsulin), with 74/162 (46%) selecting insulin lente administered twice daily (BID). The median dose for insulin lente BID was 0.43 U/kg/injection (range, 0.05-1.29 U/kg/injection). 62 out of 162 respondents (38%) selected insulin NPH (Humulin^®-N, Novolin^®-N) BID at a median dose of 0.43 U/kg/injection (range, 0.11-2.15 U/kg/injection). For the feline case, 120/151 participants (79%) selected insulin glargine 100 U/ml, with 118/151 (78%) selecting insulin glargine BID. The median dose for insulin glargine BID was 0.17 U/kg/injection (range, 0.04-1.87 U/kg/injection). The survey data describe current prescribing practices and clinical decision-making. As options for novel insulins and diabetic therapies expand, additional studies focused on outcomes related to clinical control, cost efficacy, and quality-of-life for pet and owner are needed.