인슐린
Insulin
Insulin (Regular, Lispro, Isophane/NPH, Protamine Zinc/PZI, Porcine Zinc/Lente, Glargine, Detemir)
다른 이름: Vetsulin · Caninsulin · ProZinc · Humulin · Novolin · Lantus · Levemir · Humalog · Regular insulin · NPH · PZI · Lente · Glargine · Detemir · Lispro · Crystalline Zinc Insulin · Isophane Insulin
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Diabetic ketoacidosis (Intermittent IM technique) | 0.2 Units/kg IM into muscles of the rear legs; repeat IM doses of 0.1 Units/kg hourly. As blood glucose approaches 250 mg/dL, switch to IM regular insulin at 0.1-0.3 Units/kg q4-6h or subcutaneous q6-8h. | IM, SC | hourly, then q4-8h | Until stabilized | 🌎 NA |
| Diabetic ketoacidosis (Constant Low-Dose Infusion) | 2.2 Units/kg regular insulin added to 250 ml of 0.9% sterile saline. Adjust infusion rate based upon hourly blood glucose determinations. Once blood glucose approaches 250 mg/dL switch to IM regular insulin every 4-6 hours or SC at 0.1-0.4 Units/kg q6-8h. | IV, then IM/SC | CRI, then q4-8h | Until stabilized | 🌎 NA |
| Severe hyperkalemia (>8 mEq/L) | 0.25-0.5 Units/kg slow IV bolus followed by 50% dextrose (4 mL/U of administered insulin); OR 0.5-1 Units/kg in parenteral fluids plus 2 grams dextrose per unit insulin administered | IV | Once | — | 🌎 NA |
| Uncomplicated diabetes mellitus (Vetsulin) | 0.5 Units/kg SC once daily concurrently with or right after a meal. If twice daily treatment is initiated, the two doses should be 25% less than the once daily dose. Alternatively: 0.5 Units/kg SC twice daily. | SC | q24h or q12h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (NPH or Lente) | 0.25 Units/kg twice a day | SC | q12h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (Glargine) | 0.25-0.5 Units/kg SC q12h | SC | q12h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (Detemir) | 0.1-0.2 Units/kg SC q 12 hours | SC | q12h | Lifelong | 🌎 NA |
- Diabetic ketoacidosis (Intermittent IM technique): Initial doses may be reduced by 25-50% in animals with severe hypokalemia. Goal is to slowly lower blood glucose to 200-250 mg/dL over 6-10 hours.
- Diabetic ketoacidosis (Constant Low-Dose Infusion): Run approx 50 mL of insulin-containing fluid through drip set prior to administration to saturate binding sites.
- Severe hyperkalemia (>8 mEq/L): Use Regular insulin only.
- Uncomplicated diabetes mellitus (NPH or Lente): Initial insulin of choice for establishing control.
- Uncomplicated diabetes mellitus (Glargine): Used in poorly-controlled dogs where NPH/Lente are ineffective due to short duration.
- Uncomplicated diabetes mellitus (Detemir): Note the lower starting dose; canine receptors are 4x more sensitive to detemir than human receptors.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Diabetic ketoacidosis (Regular insulin) | Same protocol using regular insulin as described for dogs | IM, IV, SC | Varies | Until stabilized | 🌎 NA |
| Diabetic ketoacidosis (Glargine) | 2 Units per cat SC and 1 Unit per cat IM (regardless of body weight) initially; repeat the IM dose 4 or more hours later if BG > 250-290 mg/dL; repeat the SC dose every 12 hours. | SC and IM | Initially, then q12h SC | Until stabilized | 🌎 NA |
| Severe hyperkalemia | 0.5 to 1 Unit/kg IM regular insulin plus 2 grams dextrose per unit of insulin IV | IM | Once | — | 🌎 NA |
| Uncomplicated diabetes mellitus (Glargine, Detemir, or PZI) | Blood glucose <360 mg/dL: 0.25 Units/kg of ideal body weight SC every 12 hours; Blood glucose >=360 mg/dL: 0.5 Units/kg of ideal body weight SC every 12 hours | SC | q12h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (ProZinc) | 0.2-0.7 Units/kg SC every 12 hours given concurrently with or right after a meal | SC | q12h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (Vetsulin) | 0.5 Units/kg SC once daily | SC | q24h | Lifelong | 🌎 NA |
| Uncomplicated diabetes mellitus (Lente) | 1 Unit per cat SC twice daily for cats <4kg & 1.5-2 Units/cat twice daily for cats >4kg. Alternatively: 0.25 Units/kg SC twice daily if BG 216-342 mg/dL; 0.5 Units/kg SC twice daily if BG>360mg/dL. | SC | q12h | Lifelong | 🌎 NA |
- Uncomplicated diabetes mellitus (Glargine, Detemir, or PZI): If no monitoring in first week, begin with 1 Unit per cat every 12 hours.
- Uncomplicated diabetes mellitus (ProZinc): Goal: glucose nadir between 80 & 150 mg/dL.
페렛
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Diabetes mellitus | 0.5-1 Unit per ferret SC twice daily. Alternatively: 0.1-0.5 Units/kg IM or SC twice daily to start; adjust to optimal dose. | SC, IM | q12h | Lifelong | 🌎 NA |
- Diabetes mellitus: May require insulin to be diluted.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Diabetes mellitus | Initially, 0.1-0.2 Units/kg regular insulin. When stabilized, NPH insulin can be started. Dose range is 0.067-3.3 Units/kg IM every 12-24 hours. | IM | q12-24h | Lifelong | 🌎 NA |
- Diabetes mellitus: Highly variable dose needed. Monitor for hypoglycemia.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Diabetes mellitus | 0.51 Unit/kg of PZI insulin OR 0.15 Units/kg IM or SC twice daily | IM, SC | q12h | As needed | 🌎 NA |
| Hyperlipemia in ponies | For a 200 kg pony: PZI 30 Units (total dose) IM every 12 hours on odd days (given with 100 grams glucose orally once daily); PZI 15 Units (total dose) IM every 12 hours on even days (given with 100 grams galactose orally once daily) | IM | q12h | Until hyperlipemia resolves | 🌎 NA |
- Diabetes mellitus: True DM is rare; mostly secondary to pituitary tumors (insulin-resistant).
소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of ketosis | 200 Units (total dose) SC once every 48 hours | SC | q48h | As needed | 🌎 NA |
- Adjunctive treatment of ketosis: Using PZI insulin.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
인슐린은 랑게르한스섬의 베타 세포에서 생성되는 중요한 펩타이드 호르몬입니다. 수의학에서 당뇨병 및 당뇨병성 케톤산증(DKA) 치료의 핵심입니다.
제제는 작용 발현 및 지속 시간에 따라 크게 분류됩니다:
- 속효성 (레귤러, 리스프로): 주로 병원 환경에서 DKA 또는 중증 고칼륨혈증의 급성 안정화에 사용됩니다. 레귤러 인슐린은 정맥 투여가 가능한 유일한 제제입니다.
- 중간형 (NPH, 렌테): 반려견의 유지 요법에 흔히 사용됩니다. 돼지 인슐린은 반려견 인슐린과 구조적으로 동일하여 항인슐린 항체 형성 위험을 최소화합니다.
- 지속형 (PZI, 글라진, 디터미어): 개보다 인슐린 대사가 빠른 고양이의 유지 요법에 자주 사용됩니다.
임상 요점: 고양이 당뇨병은 종종 사람의 제2형 당뇨병과 유사하며, 지속형 인슐린(예: 글라진)의 조기 및 적극적인 사용과 저탄수화물 식단을 병행하면 관해에 도달할 수 있습니다. 반려견 당뇨병은 일반적으로 사람의 제1형 당뇨병과 유사하여 평생 외부 인슐린 투여가 필요합니다.
작용 기전
Insulin initiates its action by binding to the tyrosine kinase insulin receptor on the cell membrane.
Mechanism Pathway: Receptor binding → Autophosphorylation → Activation of Insulin Receptor Substrates (IRS) → Activation of the PI3K/Akt pathway → Translocation of GLUT4 transport proteins to the cell surface → Rapid facilitated diffusion of glucose into skeletal muscle and adipose tissue.
Metabolic Effects:
- Carbohydrate metabolism: Promotes cellular glucose uptake and hepatic glycogenesis; inhibits glycogenolysis and gluconeogenesis.
- Lipid metabolism: Stimulates lipogenesis and potently inhibits lipolysis and ketogenesis (crucial for resolving DKA).
- Protein metabolism: Increases amino acid uptake and protein synthesis.
- Electrolyte shift: Drives potassium and magnesium into the intracellular space (utilized therapeutically for life-threatening hyperkalemia).
안전성·주의사항
금기사항
- Episodes of hypoglycemia (absolute contraindication)
- Systemic allergy to pork or pork products (specifically for Vetsulin/porcine lente)
부작용
- Hypoglycemia (most common and potentially life-threatening)
- Insulin-induced hyperglycemia ('Somogyi effect' due to counter-regulatory hormone release following hypoglycemia)
- Insulin antagonism or resistance
- Rapid insulin metabolism
- Local hypersensitivity reactions to 'foreign' proteins
- Lipodystrophy at the injection site (if sites are not rotated)
주의
Because there are no alternatives for insulin in diabetic indications, there are no absolute contraindications except during hypoglycemia.
- Antibody Formation: Beef/pork insulin produces antibody formation in ~45% of dogs, leading to erratic control. Pork insulin is identical to canine insulin and is preferred. Cats have a low incidence of antibody production regardless of source.
- Injection Site: Do not inject at the exact same site day after day to prevent lipodystrophic reactions.
- Prescription Safety: Do NOT abbreviate Units as 'U', as it significantly increases the rate of transcription and fatal dosage errors (often misread as a zero).
약물 상호작용
Can have variable effects on glycemic control and can mask the clinical signs associated with hypoglycemia.
Can mask the signs associated with hypoglycemia.
Insulin alters serum potassium levels; concurrent use requires close monitoring for cardiac arrhythmias, especially with concurrent diuretics.
May potentiate the hypoglycemic activity of insulin.
May decrease the hypoglycemic activity of insulin (cause insulin resistance).
모니터링
- Blood glucose (serial curves or continuous monitoring)
- Patient weight
- Appetite and water intake
- Urine output
- Blood or urine ketones (if DKA suspected)
- Fructosamine (goal <450 micromol/L) or glycosylated hemoglobin
약동학
반감기
흡수
Varies widely by formulation. Regular insulin has immediate onset IV, and rapid onset (10-30 mins) IM/SC. Intermediate (NPH/Lente) and long-acting (PZI/Glargine/Detemir) formulations form microprecipitates or bind to tissues to delay absorption and prolong effect.
분포
Distributed widely throughout the body. Affects primarily liver, muscle, and adipose tissues.
대사
Metabolized mainly by the liver and kidneys (also muscle and fat to a lesser degree) by enzymatic reduction to form peptides and amino acids. About 50% of insulin reaching the liver via the portal vein is destroyed.
배설
Filtered by the renal glomeruli and reabsorbed by the tubules, which also degrade it. Severe renal impairment affects clearance more than hepatic disease.
과다투여
Overdosage of insulin leads to hypoglycemia, which can be rapidly fatal or cause permanent brain damage if untreated.
Clinical Signs:
- Weakness, lethargy, ataxia
- Shaking, muscle fasciculations
- Head tilting, bizarre behavior, blindness
- Restlessness, extreme hunger
- Seizures and coma
Treatment:
- Mild: Offer the animal its usual food.
- Severe (e.g., seizures): Rub oral dextrose solutions (e.g., Karo® syrup) on the oral mucosa (do not pour down the throat to avoid aspiration).
- Veterinary Intervention: Intravenous injections of 50% dextrose solutions (small amounts, slowly administered—usually 2-15 mL).
- Monitoring: Once alleviated (usually within 1-2 minutes), monitor closely with serial blood glucose levels to prevent recurrence (especially with long-acting insulins) and adjust future doses.
제품
제형
- Regular (Crystalline Zinc) injection
- Lispro injection
- Isophane (NPH) suspension
- Protamine Zinc (PZI) suspension
- Porcine Zinc (Lente) suspension
- Glargine injection
- Detemir injection
동물용의약품
- Vetsulin (Porcine insulin zinc suspension 40 Units/mL)
- Caninsulin (Porcine insulin zinc suspension 40 Units/mL - Canada/Europe)
- ProZinc (Protamine zinc recombinant human insulin 40 Units/mL)
인용의약품
- Humulin R / Novolin R (Regular 100 Units/mL)
- Humalog (Lispro 100 Units/mL)
- Humulin N / Novolin N (NPH 100 Units/mL)
- Humulin 70/30 / Novolin 70/30 (NPH/Regular mixture 100 Units/mL)
- Humulin 50/50 (NPH/Regular mixture 100 Units/mL)
- Lantus (Glargine 100 Units/mL)
- Levemir (Detemir 100 Units/mL)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store in the refrigerator (36-46°F / 2-8°C). Do not freeze. Avoid direct sunlight and extreme heat. Regular and NPH insulin may be stored in plastic syringes under refrigeration for up to 28 days. Glargine (Lantus) officially has a 28-day discard date at room temp, but clinical reports indicate opened vials stored in the refrigerator can be used for up to 6 months (discard if discolored). Detemir (Levemir) has a 42-day discard date.
보호자 정보
당뇨병 반려동물을 관리하는 데는 헌신이 필요하지만, 곧 일상 생활의 일부가 됩니다. 성공적인 관리를 위한 핵심 사항은 다음과 같습니다:
- 보관: 인슐린은 냉장고에 보관하십시오. 극한의 온도는 단백질을 파괴하므로 절대 얼리거나 뜨거운 차 안에 두지 마십시오. 주사 시 불편함을 줄이기 위해 주사기에 약을 뽑은 후 실온에 도달하게 한 뒤 주사하십시오.
- 약병 취급: 양 손바닥 사이에서 약병을 부드럽게 굴려 섞습니다. 인슐린 분자가 손상될 수 있으므로 세게 흔들지 마십시오 (Vetsulin과 같은 특정 브랜드에 대해 수의사의 특별한 지시가 없는 한).
- 주사기 안전: 항상 올바른 주사기를 사용하십시오! U-40 주사기(빨간색 뚜껑)는 U-40 인슐린(예: Vetsulin 또는 ProZinc)용입니다. U-100 주사기(주황색 뚜껑)는 U-100 인슐린(예: 글라진 또는 NPH)용입니다. 이를 혼동하면 치명적인 과다 복용을 초래할 수 있습니다.
- 주사 방법: 피하에 주사합니다. 인슐린 흡수를 방해하는 피하 멍울이 생기는 것을 방지하기 위해 매일 주사 부위를 번갈아 가며 (예: 가슴 왼쪽, 가슴 오른쪽, 왼쪽 옆구리, 오른쪽 옆구리) 주사하십시오.
- 저혈당증: 이는 응급 상황입니다. 무기력, 비틀거림, 떨림, 허공 응시 또는 발작이 있는지 관찰하십시오. 이러한 증상이 나타나면 즉시 반려동물의 잇몸에 콘 시럽(Karo 시럽)이나 꿀을 문지르고 수의사에게 연락하십시오. 발작 중인 반려동물의 입에 손가락을 넣지 마십시오.
- 여행: 비행기 탑승 시 인슐린은 기내 수하물에 보관하십시오. X-ray 검색대를 한 번 통과하는 것은 괜찮지만 반복적인 노출은 피하십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.