Abstract
Background: Diabetic ketoacidosis (DKA) is an acute metabolic healthcare crisis in patients with diabetes mellitus. The current study aimed to compare the effectiveness of rapid-acting insulin analog administered subcutaneously with regular insulin infused intravenously among the DKA patients.
 Methodology: In this prospective open labelled study, 100 consecutive DKA patients were randomly assigned to two groups. Group 1 patients were admitted to the intensive care unit (ICU) and treated with intravenous regular insulin infusion. Group 2 patients were managed in the emergency medical ward with subcutaneous rapid-acting insulin. Response to the therapy was assessed by the follow-up investigations of the biochemical parameters, including blood glucose concentration, serum ketones, pH, serum electrolytes including bicarbonates, sodium and potassium concentration until the resolution of DKA. Furthermore, the overall duration of therapy (blood glucose level < 250 mg/dl), time and amount of insulin administered until the resolution of DKA, were also assessed.
 Results: The baseline clinical and biochemical parameters were similar between the two treatment groups except for blood glucose and sodium concentration. The mean random blood sugar (RBS), acid-base parameters and concentration of ketone bodies were significantly improved from admission until the resolution of DKA. There was no significant difference in the duration of therapy (p=0.07). While the time and amount of insulin therapy required until resolution of DKA were significantly reduced among the patients treated subcutaneously with rapid-acting insulin, i.e. 16.36 ± 6.92 hrs and 59.28 ± 30.05 units (p<0.05).
 Conclusion: The patients with less complicated DKA can be managed with rapid-acting insulin analog in the medical wards obviating the need for admission to the ICU. With relatively better outcomes, it is an effective alternative to regular intravenous insulin infusion for DKA resolution.
Highlights
Diabetic ketoacidosis (DKA) is a severe lifethreatening emergency condition triggered by abnormally high blood glucose concentration among patients with type 1 and type 2 diabetes
The study results showed that the administration of subcutaneous rapid-acting insulin was as effective as the treatment with intravenous infusion of regular insulin among the DKA patients
The mean blood glucose concentration and acid-base parameters at the resolution of DKA among the patients treated with rapid-acting insulin (RBS 292.54 ± 47.81 mg/dl, pH 7.34 ± 0.08, bicarbonate 24.07 ± 1.65 mmol/l) were similar to those observed among the patients treated with regular intravenous insulin (RBS 303.24 ± 50.94 mg/dl, pH 7.34 ± 0.07, bicarbonate 23.74 ± 2.17 mmol/l)
Summary
Diabetic ketoacidosis (DKA) is a severe lifethreatening emergency condition triggered by abnormally high blood glucose concentration among patients with type 1 and type 2 diabetes. This serious metabolic derangement involves the biochemical triad of uncontrolled high blood glucose, increased ketones and metabolic acidosis. The current study aimed to compare the effectiveness of rapid-acting insulin analog administered subcutaneously with regular insulin infused intravenously among the DKA patients. While the time and amount of insulin therapy required until resolution of DKA were significantly reduced among the patients treated subcutaneously with rapid-acting insulin, i.e. 16.36 ± 6.92 hrs and 59.28 ± 30.05 units (p
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