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

Abstract

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.

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

“…76 Potential candidate patients include those who are alert and do not otherwise need admission to a critical care area, have a pH above 7.0, and bicarbonate of at least 10 mmol/L (≥10 mEq/L) 77. Four prospective randomized studies in adult patients with diabetic ketoacidosis compared subcutaneous rapid acting insulin (initial bolus of 0.3 units/kg followed by 0.1-0.2 units/kg every 1-2 hours) with conventional diabetic ketoacidosis treatment and found no difference in patient outcomes 77787980. With subcutaneous insulin regimens, administration of intravenous fluids and electrolytes, as well as monitoring, is identical to what is recommended with intravenous insulin therapy.…”

Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?

“…In a prospective, randomized clinical trial in India, Karoli and coworkers reported that once the DKA patient is evaluated in the ED, and categorized in the severity score, direct admission to a regular ward provided no additional mortality and the only complication noted was hypoglycemia. Other groups have used other classifications to allocate resources for patients with DKA[ 15 ]. In a retrospective study, Marinac and Mesa, using laboratory criteria (serum bicarbonate, anion gap, base excess and serum osmolality), and diastolic blood pressure, patients were grouped in 5 grades (Grade 0 - IV)[ 19 ].…”

Use of lispro insulin for treatment of diabetic ketoacidosis in cats

“…7 For this reason, IV infusion of regular insulin has been the mainstay of treatment of DKA as it causes a more predictable fall in blood glucose and it allows for rapid adjustments. 8 Insulin lispro is a genetically engineered analogue of human insulin in which proline at position B28 and lysine at position B29 are inverted in their sequence reducing the formation of insulin dimers and hexamers. This structural change ensures more rapid absorption and elimination from the subcutaneous injection site, resulting in the rapid onset and a short duration of hypoglycaemic activity.…”