胰島素
Insulin
Insulin (Regular, Lispro, Isophane/NPH, Protamine Zinc/PZI, Porcine Zinc/Lente, Glargine, Detemir)
別名: Vetsulin · Caninsulin · ProZinc · Humulin · Novolin · Lantus · Levemir · Humalog · Regular insulin · NPH · PZI · Lente · Glargine · Detemir · Lispro · Crystalline Zinc Insulin · Isophane Insulin
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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).
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
胰島素是一種由胰島β細胞產生的關鍵胜肽激素。它是獸醫學中治療糖尿病和糖尿病酮酸中毒 (DKA) 的基石。
製劑根據其起效和持續時間大致分類：
- 短效 (常規 Regular, 賴脯 Lispro)： 主要用於醫院環境中 DKA 或嚴重高血鉀的急性穩定。常規胰島素是唯一可以靜脈注射的劑型。
- 中效 (NPH, 豬鋅 Lente)： 常見於犬隻的維持治療。豬胰島素在結構上與犬胰島素完全相同，可將抗胰島素抗體形成的風險降至最低。
- 長效 (PZI, 甘精 Glargine, 地特 Detemir)： 常用於貓的維持治療，因為貓代謝胰島素的速度比狗快。
臨床要點： 貓糖尿病通常類似於人類的第2型糖尿病，透過早期積極使用長效胰島素（如甘精胰島素）並配合低碳水化合物飲食，可能會進入緩解期。犬糖尿病通常類似於人類的第1型糖尿病，需要終身注射外源性胰島素。
作用機制
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).
安全性與警告
禁忌症
- Episodes of hypoglycemia (absolute contraindication)
- Systemic allergy to pork or pork products (specifically for Vetsulin/porcine lente)
不良反應
- 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)
注意事項
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).
藥物相互作用
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).
監測
- 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
藥物動力學
半衰期
吸收
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.
分佈
Distributed widely throughout the body. Affects primarily liver, muscle, and adipose tissues.
代謝
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.
排除
Filtered by the renal glomeruli and reabsorbed by the tubules, which also degrade it. Severe renal impairment affects clearance more than hepatic disease.
過量
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.
可用產品
劑型
- Regular (Crystalline Zinc) injection
- Lispro injection
- Isophane (NPH) suspension
- Protamine Zinc (PZI) suspension
- Porcine Zinc (Lente) suspension
- Glargine injection
- Detemir injection
獸醫用
- 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)
人用標示
- 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)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
照顧糖尿病寵物需要耐心與承諾，但它很快就會成為日常生活的一部分。以下是成功的關鍵要點：
- 儲存： 將胰島素保存在冰箱中。切勿冷凍或將其留在炎熱的車內，因為極端溫度會破壞蛋白質。注射前讓抽好藥劑的空針回到室溫，以減少注射時的不適。
- 處理藥瓶： 在手掌間輕輕滾動藥瓶以混合藥液。切勿劇烈搖晃（除非獸醫針對特定品牌如 Vetsulin 有特別指示），因為這會破壞胰島素分子。
- 空針安全： 務必使用正確的空針！U-40 空針（紅蓋） 專用於 U-40 胰島素（如 Vetsulin 或 ProZinc）。U-100 空針（橘蓋） 專用於 U-100 胰島素（如 Glargine 或 NPH）。混淆兩者可能導致致命的劑量錯誤。
- 注射技巧： 進行皮下注射。每天輪替注射部位（例如：左胸、右胸、左腹側、右腹側），以防止皮下形成硬塊，這會阻礙胰島素的吸收。
- 低血糖： 這是緊急情況。注意寵物是否出現虛弱、絆倒、發抖、發呆或癲癇。如果發生這種情況，請立即將 玉米糖漿 (Karo syrup) 或蜂蜜塗抹在寵物的牙齦上，並聯絡您的獸醫。切勿將手指放入正在抽搐的寵物口中。
- 旅行： 搭機時，請將胰島素放在隨身行李中。通過一次 X 光檢查是安全的，但應避免反覆暴露於輻射中。
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