Diabetic Ketoacidosis Updates: Titratable Insulin Infusions and Long-Acting Insulin Early.

Justin Kinney,Mania Gharibian,Oshin Baroi,Fred A Luchette

doi:10.1155/2021/1601553

Abstract

Background To compare a titratable insulin infusion order set (vs. nontitratable) and early administration of long-acting insulin in adult patients with diabetic ketoacidosis (DKA). Methods Single health system, retrospective study of adult patients admitted to the intensive care unit (ICU) for DKA. The primary outcomes were insulin infusion duration and ICU/hospital length of stays (LoS). Secondary outcomes included ICU/hospital survival, hypoglycemia, and hypokalemia. Results 151 patients were included in the titratable versus nontitratable insulin infusion comparison. Patients treated with the titratable insulin had shorter hospitalization (6.4 vs. 10.4 days, p=0.03) and reduced the number hypoglycemic events by over half (20.6% vs. 46.0%, p < 0.01). 110 patients were identified to compare overlapping a long-acting insulin for more than 4 h with the insulin infusion versus the standard 1-2 h overlap. Patients who received the insulin early spent over 18 h longer on the infusion (p < 0.01). Conclusions A titratable insulin infusion added to the institutional DKA order set was associated with fewer days in the hospital and a significant reduction in hypoglycemic events. Furthermore, overlapping the long-acting insulin earlier with the insulin infusion early showed no benefit and could potentially be worse than the standard overlap.

Highlights

Diabetic ketoacidosis (DKA) is a life-threatening medical condition with acute metabolic complications generally requiring intensive care unit (ICU) admittance for higher level of care and correction of life-threatening acidosis
Ere is even exploration for mild cases of diabetic ketoacidosis (DKA) to be managed with subcutaneous insulins alone outside of the ICU [3]. e order set at our health system changed from a nontitratable insulin infusion to titratable, adjusting the rate of insulin infusion based on the patient’s blood sugars
Patients who appeared to having longer hospitalizations were those that the insulin was reduced to the lowest amount, 0.025 units/kg/h, overnight often resulting in a worsening acidosis by morning. is occurs because these patients require a minimum amount of insulin to be able to resolve the underlying ketoacidosis, despite normalized blood sugars, and such a small amount of insulin typically is not sufficient

Summary

Background

To compare a titratable insulin infusion order set (vs. nontitratable) and early administration of long-acting insulin in adult patients with diabetic ketoacidosis (DKA). 151 patients were included in the titratable versus nontitratable insulin infusion comparison. Patients treated with the titratable insulin had shorter hospitalization (6.4 vs 10.4 days, p 0.03) and reduced the number hypoglycemic events by over half (20.6% vs 46.0%, p < 0.01). 110 patients were identified to compare overlapping a long-acting insulin for more than 4 h with the insulin infusion versus the standard 1-2 h overlap. A titratable insulin infusion added to the institutional DKA order set was associated with fewer days in the hospital and a significant reduction in hypoglycemic events. Overlapping the long-acting insulin earlier with the insulin infusion early showed no benefit and could potentially be worse than the standard overlap

Introduction

Results and Discussion

Results