Long-term antiepileptic therapy is often not required in dogs with insulin-induced hypoglycemic seizures: a multicenter retrospective study of 49 dogs.

Abstract

OBJECTIVE: To characterize the clinical features, management, and short- and long-term outcomes of dogs experiencing insulin-induced hypoglycemic seizures (IIHS). METHODS: Dogs with documented blood glucose concentrations < 80 mg/dL (4.4 mmol/L) within 12 hours of insulin administration were retrospectively identified from 14 private practice emergency and specialty hospitals in the US (January 2017 to January 2025). Dogs were classified as having IIHS or insulin-induced hypoglycemia (IIH) without seizures. Data collected included signalment, insulin type and dose, blood glucose concentration at presentation, time to glucose correction, seizure characteristics, antiepileptic drug (AED) use, length of hospitalization, and survival to discharge. Associations between clinical variables and seizure occurrence were assessed with logistic regression. RESULTS: 49 dogs met the inclusion criteria: 34 with and 15 without seizure activity. Body weight showed a curvilinear association with seizure occurrence, with higher odds at low (< 10-kg) and high (> 25-kg) weights (body weight: OR, 0.26; 95% CI, 0.07 to 0.97; body weight2: OR, 1.41; 95% CI, 1.04 to 1.93). Antiepileptic drugs were used in 7 of 34 dogs (20.6%); 3 required long-term management. Multiple seizures were associated with AED use. No significant differences were found in insulin type, amount administered, or time to glucose correction between groups. CONCLUSIONS: IIHS are common in diabetic dogs; however, long-term neurologic sequelae and the need for ongoing AEDs are uncommon. CLINICAL RELEVANCE: Future studies are warranted to better identify patients at increased risk for long-term neurologic complications and to establish criteria for initiating AEDs. Additionally, research evaluating IIHS associated with other insulin preparations (eg, detemir, glargine) is needed.