Comparison of short and intermediate-acting insulin protocols for perioperative glycaemic management in diabetic dogs undergoing phacoemulsification: a randomised clinical trial.

Neither short-acting nor intermediate-acting insulin reliably achieves target perioperative glycaemia in diabetic dogs; vigilant monitoring is essential.

This prospective, randomised, double-blinded, noninferiority clinical trial evaluated two perioperative insulin protocols in 52 diabetic dogs undergoing phacoemulsification surgery. Dogs received either intramuscular short-acting (neutral/regular) insulin (NEU; n=25) or subcutaneous intermediate-acting biphasic insulin (CAN; n=27) on the morning of surgery, with standardised intravenous glucose supplementation as needed. Blood glucose (BG) was monitored for 600 minutes post-injection, with a target range of 8.3–11.1 mM. Noninferiority of the short-acting protocol was not demonstrated; the geometric mean BG ratio (NEU:CAN) was 1.03 with a 95% CI of 0.86–1.23, exceeding the prespecified noninferiority margin of 1.10. Both protocols achieved poor glycaemic control overall, with hyperglycaemia (BG >11.1 mM) occurring in over 96% of all dogs. Median proportions of readings within target range were low and not significantly different between groups (0.11 for NEU vs. 0.17 for CAN; p=0.413). Hypoglycaemia incidence was low (4.0% NEU vs. 11.1% CAN; p=0.362). High inter-individual BG variability was noted in both groups. Nonglycaemic complications, including hypotension, were comparable. The authors conclude that neither protocol reliably achieves target glycaemia perioperatively, underscoring the need for frequent BG monitoring and individualised insulin or glucose adjustments regardless of insulin type selected.

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