Is Subcutaneous Administration of Rapid-Acting Insulin as Effective as Intravenous Insulin for Treating Diabetic Ketoacidosis?

Mazer, Maryann; Chen, Esther

doi:10.1016/j.annemergmed.2008.07.023

Cited by 29 publications

(18 citation statements)

References 7 publications

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“…Treatment of DKA in intensive care unit was associated with 39% higher hospitalization charges. [15] They had the similar conclusions in another study done with insulin as part 1-2 hourly. [16] Della Manna et al .,[17] also found rapid acting insulin analog as safe and effective alternative to regular insulin in their study done in pediatric patients with DKA.…”

Section: Discussionsupporting

confidence: 67%

“…Umpierrez et al .,[15] in a prospective, randomized study compared the efficacy and safety of subcutaneous insulin lispro every hour with that of standard low dose intravenous infusion of regular insulin in adult patients with DKA. They observed comparable blood glucose decrease rates and control of ketoacidosis between the two groups of adults receiving subcutaneous lispro 1-2 hourly and a group treated with intravenous regular insulin.…”

Section: Discussionmentioning

confidence: 99%

“…[14] Mazer et al . [15] have reviewed this issue based on several studies[16–20] and concluded that treatment of patients with mild to moderate DKA with subcutaneous rapid acting insulin analogs (lispro and aspart) given hourly or 2 hourly in non-intensive care settings is as effective and safe as the treatment with continuous intravenous regular insulin in the intensive care unit. They also suggested that that use of insulin analogs may confer an overall cost saving, obviating the need for infusion pumps and admission in intensive care unit in certain institutions.…”

Section: Introductionmentioning

confidence: 99%

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Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs

et al. 2011

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Aim:To compare the efficacy and safety of rapid acting insulin analog lispro given subcutaneously with that of standard low-dose intravenous regular insulin infusion protocolin patients with mild to moderate diabetic ketoacidosis.Materials and Methods:In this prospective, randomized and open trial, 50 consecutive patients of mild to moderate diabetic ketoacidosis were randomly assigned to two groups. The patients in group 1 were treated with intravenous regular insulin infusion and admitted in intensive care unit. The patients in group 2 were treated with subcutaneous insulin lispro 2 hourly and managed in the emergency medical ward. Response to therapy was assessed by duration of treatment and amount of insulin administered until resolution of hyperglycemia and ketoacidosis, total length of hospital stay, and number of hypoglycemic events in the two study groups.Results:The baseline clinical and biochemical parameters were similar between the two groups. There were no differences in the mean duration of treatment and amount of insulin required for correction of hyperglycemia and ketoacidosis. There was no mortality and no difference in the length of hospital stay between the two groups. The length of stay and amount of insulin required for correction of hyperglycemia was greater in patients who had infection as the precipitating cause than those with poor compliance. The hypoglycemic events were higher in the regular insulin group (2 vs1) than in the lispro group.Conclusion:Patients with uncomplicated diabetic ketoacidosis can be managed in the medical wards with appropriate supervision and careful monitoring. Rapid acting insulin analog lispro is a safe and effective alternative to intravenous regular insulin for this subset of patients.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs

et al. 2011

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“…In this regard, a recent evidence-based review concluded that the use of subcutaneously administered rapid-acting insulin analogs is safe and effective for the management of uncomplicated DKA [31]. All the 60 DKA episodes enrolled in our randomized clinical trial received the same fluid replacement therapy described above.…”

Section: Alternative Dka Treatment Protocolmentioning

confidence: 99%

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Savoldelli

Farhat

Manna

2010

Diabetol Metab Syndr

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DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.

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“…Advantages of the SC route include the possibility of selfadministration, greater mobility for patients, it provides an alternative for patients with poor venous access and can be administered at home, away from the hospital setting [2]. Cost is another element to take into account, and several studies have shown the cost effectiveness of SC delivery over the IV drug route [3][4][5][6]. In addition, out of pocket costs for patients and their families having to take time off work and travel to hospital for IV treatment could be underestimated.…”

Section: Introductionmentioning

confidence: 99%

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review

Stoner

Harder

Fallowfield

et al. 2014

Patient

112

102

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Is Subcutaneous Administration of Rapid-Acting Insulin as Effective as Intravenous Insulin for Treating Diabetic Ketoacidosis?

Cited by 29 publications

References 7 publications

Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs

Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review

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