Management of Diabetic Ketoacidosis in Severe Insulin Resistance

Robinson, Cemre; Cochran, Elaine; Görden, Phillip; Brown, Rebecca

doi:10.2337/dc16-0635

Cited by 9 publications

(11 citation statements)

References 5 publications

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“…From the clinical point of view among the patients with ketoacidosis three sequential stages of DKA were distinguished: І -moderate ketoacidosis, ІІ -precoma or uncompensated ketoacidosis, ІІІ -coma stage [3,12]. Considering clinical symptoms (according to the clinical picture above described) during the hospitalization in the anesthesiology department it was revealed that 8 persons had the DKA of the І stage, 41 persons -the ІІ stage, 6 persons -the ІІІ stage.…”

Section: Resultsmentioning

confidence: 99%

“…During the following course of DKA with the right tactics of the management of the patient with type 2 DM the absence of this dose did not influence, because in our opinion without the differentiation for the body mass and insulin sensitivity, without the consideration of the different insulin absorption rate this injection way and injection dose is not reasonable. No recommendation to inject intramuscularly 20 units at the pre-hospital stage was found in the foreign literature [3][4][5][6][11][12][13][14][15][16], except the recommendations of the medical specialized assistance in the Russian Federation [16] which still remain unchanged in 2017 [17]. For the determination of the initial dose it was calculated according to the method described above.…”

Section: Discussionmentioning

confidence: 99%

“…It was time when in the insulin therapy the large insulin doses subcutaneously were used and it was used the sodium bicarbonate in the pathogenetic therapy. Now the approaches to the insulin therapy of the DKA were revised [3][4][5][6] and they can vary in case of the rare syndromes with the expressed insulin resistance manifestations [3].…”

Section: Introductionmentioning

confidence: 99%

“…However, analyzing the data of the literature for the recent years, the glycemia level as the diagnostic criterion was revised and reduced from 13.9 mmol/l to 11 mmol/l, and the recent scientific publications claim about the high frequency of the euglycemic ketoacidosis using new groups of sugarlowering preparations or restricting carbohydrates intake with meals [7]. But the рН level and blood bicarbonates are constant within decades as indices of the severity of ketoacidosis [2][3][4][5][6]. Precisely the level of the glycemia in dynamics is the evaluation of the insulin therapy efficacy, however, only the figures of the glycemia are not important without other clinical semiotics.…”

Section: Introductionmentioning

confidence: 99%

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Нюанси Інсулінотерапії При Лікуванні Діабетичного Кетоацидозу

Nizhynska-Аstapenko¹,

Vlasenkо²

2021

Mìžnarodnij endokrinologìčnij žurnal

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Background. The well-defined program of the insulin therapy is a guarantee of efficient treatment of a patient with the diabetic ketoacidosis. The approaches to the treatment varied depending on the gained experience, however, the experts' opinions about the dose and methods of the insulin therapy are still ambiguous. The evaluation of the insulin therapy efficacy via continuous infusion by means of a syringe pump with the initial dose 0.1 unit/kg/h under the control of the glycemia without the usage of a bolus insulin dose IV and the determination of the necessary daily insulin dose on the first day of the diabetic ketoacidosis treatment. The purpose of the study -the evaluation of the insulin therapy efficacy for the diabetic ketoacidosis with syringe pump by means of the continuous infusion with the initial dose 0.1 unit/kg/h under the control of the glycemia as the principal component of the pathogenetic treatment and the determination of the necessary daily insulin dose on the first day of the diabetic ketoacidosis treatment in parallel with the rehydration start by means of physiological solution. Materials and methods. 55 patients with diabetic ketoacidosis aged from 9 to 65 years were examined. The average age of the patients was 31.58 ± 17.18 years. The specific weight of the female patients was 56 %, and male patients -44 %. 80 % of patients had the type 1 diabetes mellitus. The determination of the glucose level was carried out in the capillary blood by means of the automatic glucose analyzer. For all the patients the glycemia was controlled in an hour after the injection of 0.1 unit/kg/h of insulin and then the dose was corrected in case of necessity with the control of the glucose level. For the treatment the fast-acting insulin was used and analogues of ultra fast-acting insulins, their total dose was calculated during the first day of treatment. Results. The glycemia level during the hospitalization fluctuated from 6.7 mmol/l to 62.2 mmol/l, at average it was 23.37 ± 10.16 mmol/l. 13 % of the patients had the glycemia of 13 mmol/l. 29 % of patients had the glycemia to 20 mmol/l, and 58 % of patients had the hyperglycemia of more than 20 mmol/l. 63,6 % of patients had the desirable dynamics of glycemia level in an hour after the injection of the calculated insulin dose, the glycemia decrease within an hour was 0.5-5.3 mmol/l, but it was noted the individual sensitivity to the injected insulin dose. The daily insulin dose fluctuated from 0.5 unit/kg daily to 5.83 unit/kg a day. The median of the daily insulin dose amidst the patients was 1.36 unit/kg and more often it was 0.92-1.88 unit/kg a day (25 %; 75 %). Conclusions. The insulin dose calculated as 0.1 unit/kg/h is efficient in most cases but due to the individual sensitivity to the injected insulin and the significant factor of the treatment efficiency is the glycemia control hourly for the opportune correction of the insulin dose.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Нюанси Інсулінотерапії При Лікуванні Діабетичного Кетоацидозу

Nizhynska-Аstapenko¹,

Vlasenkо²

2021

Mìžnarodnij endokrinologìčnij žurnal

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“…Sodium–glucose cotransporter 2 (SGLT‐2) inhibitors have been proposed as a second‐line therapeutic option; however, diabetic ketoacidosis has been reported previously in a person on taselisib (an investigational PI3Kα inhibitor) and canagliflozin [4]. Because severe insulin resistance can also cause ketoacidosis [5], combining PI3Kα with SGLT2 inhibitors should be done with caution. Owing to the pattern of hyperglycaemia observed in the woman described here, with peak glucose readings ~ 6 h after the dose, and glucose nadir prior to the subsequent dose, sulfonylureas and long‐acting insulin analogues should be used with caution due to the risks of hypoglycaemia as the effects of the PI3Kα inhibitor subside.…”

Section: Answersmentioning

confidence: 99%

Novel breast cancer treatment leads to hyperglycaemia

et al. 2020

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A 66-year-old woman with pre-diabetes and hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer was started on fulvestrant, and referred to endocrinology prior to initiation of alpelisib. Because of anticipated possible hyperglycaemia, and the woman's reluctance to start fingerstick glucose monitoring, a continuous glucose monitor (CGM) was prescribed for safety. CGM data revealed the rapid onset of hyperglycaemia over the first 2 weeks of alpelisib treatment with nocturnal hyperglycaemia (Fig. 1). Hyperglycaemia occurred in the first 6 h after each dose was administered, and after 2 weeks average daily glucose levels were three times higher than baseline.Questions 1. What is alpelisib? Why does alpelisib cause hyperglycaemia?3. How is alpelisib-induced hyperglycaemia treated? FIGURE 1 Two-week continuous glucose monitoring data from woman with breast cancer the day after initiating alpelisib. The woman took alpelisib daily at 6pm. Daily average (Avg) glucose readings are shown.ª 2020 Diabetes UK

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Insulin resistance syndrome presenting with diabetic ketoacidosis — a rare presentation

Batra,

Kaur,

Kadian

et al. 2023

J Rare Dis

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We report an adolescent male who presented with diabetic ketoacidosis (DKA). He was diagnosed to have type 1 diabetes mellitus at the age of 12 years and had been initiated on insulin. On physical examination, he had a distinct senile-looking coarse facies with clinical stigmata of insulin resistance in the form of acanthosis nigricans and hypertrichosis. Additionally, he required more than 3 units/kg/day of insulin during recovery from DKA. The clinical and biochemical profile of the patient led to the suspicion of insulin resistance syndrome which was confirmed by the detection of homozygous missense variation in exon 2 of the insulin receptor gene (INSR) on clinical exome testing. The patient was put on insulin sensitizers along with insulin which led to a marked improvement in glycemic control. The case highlights the importance of a good clinical examination for a correct diagnosis and discusses the challenges in management.

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Management of Diabetic Ketoacidosis in Severe Insulin Resistance

Cited by 9 publications

References 5 publications

Нюанси Інсулінотерапії При Лікуванні Діабетичного Кетоацидозу

Нюанси Інсулінотерапії При Лікуванні Діабетичного Кетоацидозу

Novel breast cancer treatment leads to hyperglycaemia

Insulin resistance syndrome presenting with diabetic ketoacidosis — a rare presentation

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