Treatment of diabetic ketoacidosis in dogs by continuous low-dose intravenous infusion of insulin

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Summary: In a prospective clinical trial, low-dose, continuous, iv infusion of insulin (dosage, 2.2 U/kg of body weight, q 24 h) was used to treat 21 dogs with diabetic ketoacidosis. Mean (± sd) blood glucose concentration at the onset of treatment was 550 ± 150 mg/dl and after 6 hours, was 350 ± 106 mg/dl, with a mean decline of 34 ± 16 mg/dl/h. By 12 hours, mean blood glucose was 246 ± 85 mg/dl, with a mean decline of 28 ± 14 mg/dl/h during the second 6 hours of treatment. Mean duration of treatment required to reach a blood glucose concentration ≤ 250 mg/dl was 10 ± 4 hours, with a range of 4 to 24 hours. Ketonuria was observed for 26 ± 14 hours (range, 6 to 12 hours). Hypoglycemia developed in 3 of 21 dogs during treatment, but responded to iv administration of a glucose solution and to a reduction in rate of insulin delivery. Potassium supplementation was required in 15 of 21 dogs. Mean bicarbonate concentration was 11.6 ± 3.4 mEq/L before treatment and was 18.2 ± 0.7 mEq/L after 24 hours. Fifteen of 21 dogs (71%) survived to be discharged. Mean duration of treatment with the insulin infusion was 50 ± 30 hours (range, 7 to 124 hours). In this series of dogs, continuous, low-dose, iv infusion of insulin provided a gradual and consistent reduction in blood glucose concentration while ketoacidosis, electrolyte balance, and dehydration were corrected. Although hypoglycemia, hypokalemia, hypophosphatemia, and cerebral edema remain potential complications of any treatment for diabetic ketoacidosis, this protocol appears to provide a safe and effective treatment method.