Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application.

Abstract

Very-low-dose insulin application and slow-motion reequilibration plus monitored substitution of electrolytes are the basic strategies in the treatment of severe DKA. In our view, small doses of infused insulin are the main reason for the safe results of this therapy program.

Is a Priming Dose of Insulin Necessary in a Low-Dose Insulin Protocol for the Treatment of Diabetic Ketoacidosis?

“…However, the twice no load group (0.14 unit ⅐ kg Ϫ1 ⅐ h Ϫ1 , which is ϳ10 units/h of insulin in a 70-kg patient) maintained higher levels of insulin during 30 -120 min of infusion than those of the load or no load group. Table 3 demonstrates the outcome recovery data for DKA, depicting the time that predetermined values were reached for glucose, HCO 3 Ϫ , and pH. The results suggested no significant differences in these values for the three doses of insulin, but 5 of 12 patients in the no load group required additional insulin for control of their blood glucose.…”

“…A lthough positive therapeutic responses to low-dose insulin therapy have been established in adult patients with diabetic ketoacidosis (DKA) (1)(2)(3)(4)(5)(6)(7)(8), none of these studies and guidelines for the treatment of DKA, including the American Diabetes Association (ADA) Consensus and Position Statements, has ever assessed or addressed the use of a continuous insulin infusion without a loading dose of insulin (9). In the current study, we used a dose of 0.14 unit ⅐ kg Ϫ1 ⅐ h Ϫ1 without a loading dose instead of the recommended 0.1 unit ⅐ kg Ϫ1 ⅐ h Ϫ1 with a loading dose.…”

“…RESEARCH DESIGN AND METHODS -Our criteria for the diagnosis of DKA included plasma glucose Ͼ250 mg/dl, HCO 3 Ϫ Ͻ15 mEq/l, pH Ͻ7.3, and moderate ketones in the urine or blood by the nitroprusside method. A total of 37 patients were prospectively randomly assigned to three groups as follows: 1) the load group consisted of 12 patients who received a loading dose of insulin at 0.07 unit/kg body weight followed by an infusion of 0.07 unit ⅐ kg body weight Ϫ1 ⅐ h Ϫ1 ; 2) the no load group consisted of 12 patients who received only an intravenous infusion of insulin at a dose of 0.07 unit ⅐ kg body weight Ϫ1 ⅐ h Ϫ1 without a loading dose; or 3) the twice no load group consisted of 13 patients who received an infusion of insulin at a dose of 0.14 unit ⅐ kg body weight Ϫ1 ⅐ h Ϫ1 without a bolus dose.…”

Prediction and rate of infections in diabetes mellitus patients with diabetes ketoacidosis in Penang, Malaysia

“…Fever was defined as a temperature ≥ 38˚C; the method by which temperature was measure was not recorded. Leukocytosis was defined as a total while blood cell count ≥ 15,000/ mm 3 . All admissions were included in the analysis, including those with missing data.…”

“…Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate diabetes [2]. Although DKA is the evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient's requirements and the treatment, DKA-related mortality is low among patients who received standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor (which is often cessation of insulin therapy, an infection, or a myocardial infarction) [3][4][5][6][7][8].…”