Abstract
Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.
Highlights
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in people with diabetes and the leading cause of death in children with Type 1 Diabetes Mellitus (T1DM). [1,2,3] One of the important pillars in treatment of DKA is the administration of regular insulin via intravenous (IV) infusion or by frequent subcutaneous (SC) or intramuscular (IM) injections. [4,5,6] A number of controlled trials in patients with DKA showed that low-dose insulin therapy is effective no matter by which route it was given. [7, 8] Intravenous administration of regular insulin is preferred by most diabetologists because of the delayed onset of action of SC insulin and its prolonged half-life
Fisher et al [9] and Menzel et al [10] demonstrated that DKA episodes treated with IV regular insulin had experienced a more rapid fall in their plasma glucose and level of blood ketones than those treated with IM or SC insulin
The study population included 15 patients treated with continuous subcutaneous insulin infusion (CSII) and 15 patients treated with IV infusion of glulisine
Summary
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in people with diabetes and the leading cause of death in children with Type 1 Diabetes Mellitus (T1DM). [1,2,3] One of the important pillars in treatment of DKA is the administration of regular insulin via intravenous (IV) infusion or by frequent subcutaneous (SC) or intramuscular (IM) injections. [4,5,6] A number of controlled trials in patients with DKA showed that low-dose insulin therapy is effective no matter by which route it was given. [7, 8] Intravenous administration of regular insulin is preferred by most diabetologists because of the delayed onset of action of SC insulin and its prolonged half-life. [7, 8] Intravenous administration of regular insulin is preferred by most diabetologists because of the delayed onset of action of SC insulin and its prolonged half-life In their studies, Fisher et al [9] and Menzel et al [10] demonstrated that DKA episodes treated with IV regular insulin had experienced a more rapid fall in their plasma glucose and level of blood ketones than those treated with IM or SC insulin. Fisher et al [9] and Menzel et al [10] demonstrated that DKA episodes treated with IV regular insulin had experienced a more rapid fall in their plasma glucose and level of blood ketones than those treated with IM or SC insulin They showed that more than one third of patients treated with IM or SC insulin did not lower their plasma glucose by 10% in the first hour of insulin therapy. All these factors advocate its clinical superiority. [13]
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