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# Journal club: "A dose titration protocol for once-daily insulin glargine 300 U/ mL for the treatment of diabetes mellitus in dogs" by Tardo et al.
- URL: https://www.internroundtable.com/journal-club-a-dose-titration-protocol-for-once-daily-insulin-glargine-300-u-ml-for-the-treatment-of-diabetes-mellitus-in-dogs/
- Published: 2026-09-28T06:58:30.000Z
- Updated: 2026-09-28T07:02:58.000Z
- Author: Ryan Ong

## Clinical takeaways

- Insulin glargine 300 q 24hrs can achieve good glycaemic control in most dogs (72% of dogs that do not have comorbidities, 50% of dogs with concurrent diseases)
- The placement of a flash glucose monitoring system (FGMS) allows daily and hourly assessments of interstitial glucose concentrations. Coupled with insulin glargine 300 which provide relatively low variability between days, this allows for faster achievement of glycaemic control as dose adjustments can be made every 1-3 days
- The use of FGMS and insulin glargine 300 which is of lower potency and has lesser variability between days also results in a decreased risk of hypoglycaemia
- The use of Insulin glargine 300 can reduce caregiver burden as owners no longer have to time injections with meals and they no longer need to give it as often as other insulin formulations. Furthermore, meals can be skipped without having to worry about hypoglycaemia (fasting prior to procedure, GI disease)

## Study design

- Prospective multi-institutional study involving 95 client-owned diabetic dogs (Data collected from January 2021 to January 2023)
- Data collected included routine diabetes mellitus cases in which insulin glargine 300U/L and continuous interstitial glucose monitoring with freestyle libre were used
- A priori guidelines were created by 3 of the authors prior to the study (*refer to actual paper for details about dose titrations*)

**Inclusion criteria**

- Diabetes mellitus diagnosed according to the ALIVE criteria2
- Clients with dogs that 1) were newly diagnosed or 2) dogs that were poorly controlled on previous insulin formations or if the owners wanted to decrease frequency of insulin administration
- Dogs that were on corticosteroids or progestagens were included as well
- Dogs that were suffering from acute (DKA, pancreatitis) or chronic (hypercortisolism, CIE, pancreatitis) diseases were included once their clinical signs resolved and clinical improvement was noted.
- Dogs were included only if their owners could monitor their interstitial glucose levels at home using a 4 point system to categorise glycaemic control

**Exclusion criteria**

- Incomplete data
- Adverse events unrelated to the treatment of DM

## Results

- Median starting dose was 0.8 U/kg q 24 hrs
- At the end of the study, 59% of included dogs were still on insulin glargine 300 q 24 hrs and they were on median dose of 1.9 U/kg q 24hrs. 41% were receiving q12 hourly Glargine 300 at a median dose of 1.9 U/kg/day
- Dogs without concurrent diseases had a higher likelihood of receiving insulin glargine 300 q 24 hrs (72% vs 50%).
- There were no differences in the median total insulin dose and time to achieve glycaemic control between dogs with comorbidities and those without
- 5% required meal time bolus injections
- Glycaemic control was rated as excellent in 65% of dogs and the median time to achieve glycaemic control was 16 days. Clinical hypoglycaemia was noted in 6% of dogs and most were mild

## References:

1. Tardo AM, Fleeman LM, Fracassi F et al. A dose titration protocol for once-daily insulin glargine 300 U/mL for the treatment of diabetes mellitus in dogs. *Journal of Veterinary Internal Medicine* 2024;38:2120–2128\. *https://academic.oup.com/jvim/article/38/4/2120/8448751*.
2. ESVE | Project Alive. *https://www.esve.org/project\_alive/diabetes\_mellitus\_dm*. Retrieved September 28 2026.