Objective
To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed‐rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia.
Methods
We retrospectively reviewed charts from adult patients managed with a DKA order set before and after order set revision. In cohort 1 (n = 77), insulin rate was 0.1 unit/kg/h with no adjustments and dextrose was infused at 12.5 g/h after glucose reached 250 mg/dl. In cohort 2 (n = 78), insulin was reduced to 0.05 unit/kg/h concurrent with dextrose initiation at 12.5 g/h after glucose reached 200 mg/dl. The primary outcome was hypoglycaemia (glucose < 70 mg/dl) within 24 h of the first order for insulin.
Key findings
The 24‐h incidence of hypoglycaemia was 19.2% in cohort 2 versus 32.5% in cohort 1; the adjusted odds ratio was 0.46 (95% confidence interval (CI) [0.21, 0.98]; P = 0.047). The 24‐h use of dextrose 50% in water (D50W) was also reduced in cohort 2. No differences were seen in anion gap or bicarbonate normalization, rebound hyperglycaemia or ICU length of stay. In most patients who became hypoglycaemic, the preceding glucose value was below 100 mg/dl.
Conclusions
The insulin rate‐reduction protocol was associated with less hypoglycaemia and no obvious disadvantage. Robust intervention for low‐normal glucose values could plausibly achieve low hypoglycaemia rates with either approach.
Objective
The objective of this study is to validate the glycaemic safety of a simple insulin protocol using weight-based insulin rates adapted from American guidance for the management of adult diabetic ketoacidosis.
Methods
Measures of hypoglycaemia were retrospectively assessed in a single cohort of inpatient adults. The primary outcome was incidence of hypoglycaemia during insulin infusion.
Key findings
Hypoglycaemia during infusion occurred in 6/81 patients (7% [95% CI 3–16%]). Five of these occurrences were associated with protocol nonadherence.
Conclusions
The glycaemic safety of a novel, variable-rate insulin protocol directly incorporating weight-based infusion rates is supported by this single-centre study.
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