Comparative Study of Different Insulin Regimens in Management of Diabetic Ketoacidosis

Soler, Norman G.; Wright, A. D.; Fitzgerald, M. G.; Malins, J. M.

doi:10.1016/s0140-6736(75)92068-1

Cited by 69 publications

(29 citation statements)

References 16 publications

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“…The results showed no difference in response to therapy regardless of insulin dose (112,113). In the early 1970s, numerous studies demonstrated that "low-dose" or "physiological" (0.1 U и kg Ϫ1 и h Ϫ1 ) doses of insulin were effective in controlling DKA (114)(115)(116)(117)(118)(119)(120). None of these studies used randomized prospective protocols (121).…”

Section: Water and Electrolyte Metabolismmentioning

confidence: 99%

Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

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Abbreviations: AaO 2 , alveolar-to-arteriolar oxygen; AKA, alcoholic ketoacidosis; ARDS, adult respiratory distress syndrome; BUN, blood urea nitrogen; CPT, carnitine palmitoyl-transferase; CSF, cerebrospinal fluid; DKA, diabetic ketoacidosis; FFA, free fatty acid; HHS, hyperosmolar hyperglycemic state; IRI, immunoreactive insulin; PaO 2 , arteriolar partial pressure of oxygen; RDKA, recurrent DKA.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Management of Hyperglycemic Crises in Patients With Diabetes T E C H N I C A L R E V I E R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s 132DIABETES CARE, VOLUME 24, NUMBER 1, JANUARY 2001Technical Review noted in newly diagnosed obese type 2 diabetic patients (5,26,31). Therefore, the concept that the presence of DKA in type 2 diabetes is a rare occurrence is incorrect.The most common types of infections are pneumonia and urinary tract infection, accounting for 30-50% of cases (Table 4). Other acute medical illnesses as precipitating causes include alcohol abuse, trauma, pulmonary embolism, and myocardial infarction, which can occur both in type 1 and 2 diabetes (6). Various drugs that alter carbohydrate metabolism, such as corticosteroids, pentamidine, sympathomimetic agents, and ␣-and ␤-adrenergic blockers, and excessive use of diuretics in the elderly may also precipitate the development of DKA and HHS.The recent increased use of continuous subcutaneous insulin infusion pumps that use small amounts of short-acting insulin has been associated with an incidence of DKA that is significantly increased over the incidence seen with conventional methods of multiple daily insulin injections, in spite of the fact that most of the mechanical problems with insulin pumps have been resolved (6,(32)(33)(34). In the Diabetes Control and Complications Trial, the incidence of DKA in patients on insulin pumps was about twofold higher than that in the multipleinjection group over a comparable time period (35). This may be due to the exclusive use of short-acting insulin in the pump, which if interrupted leaves no reservoir of insulin for blood glucose control.Psychological factors and poor compliance, leading to omission of insulin therapy, are important precipitating factors for recurrent ketoacidosis. In young female patients with type 1 diabetes, psychological problems complicated by eating disorders may be contributing factors in up to 20% of cases of recurrent ketoacidosis (36,37). Factors that may lead to insulin omission in younger patients include fear of weight gain with good metabolic control, fear of hypoglycemia, rebellion against authority, and stress related to chronic disease (36). Noncompliance with insulin therapy has been found to be the leading precipitating cause for DKA in urban African-Americans and medically indigent patients (5,26). In addition, a recent study showed that diabetic patients without health insurance or with Medicaid alone had hospitali...

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Section: Water and Electrolyte Metabolismmentioning

confidence: 99%

Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

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“…Concern has, however, been expressed that poor absorption of insulin from the injection site in shocked patients, may lead to a delayed response, and the risk of late hypoglycaemia [19]. Others have, therefore, preferred intravenous insulin given either continuously [4] or intermittently [20].…”

Section: Discussionmentioning

confidence: 99%

“…Details of the two groups are shown in Table 1. Thirty-one were keto-acidotic [5] and 19 were hyperosmolar non-ketofic [6].…”

Section: Patientsmentioning

confidence: 99%

Serum free insulin concentrations during the treatment of diabetic coma and precoma with low dose intramuscular insulin

Asplin

Hartog

1977

Diabetologia

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Summary. Fifty patients in diabetic coma or precoma, 33 of whom had previously received insulin and had circulating insulin antibodies, were studied during treatment with a low-dose intramuscular insulin regime. In the presence of insulin antibodies, serum free insulin was separated from bound insulin by steady-state gel filtration. The initial mean serum free insulin concentration in the group of patients without insulin antibodies was 9 mUff, 1 to 2 hours after intramuscular therapy it had risen to 22 mU/1, and after 7 to 8 hours to 73 mU/1. The corresponding concentrations for the group with insulin antibodies were 13, 23 and 74 mU/1. No relationship was found between the concentrations of serum free insulin attained and the age of the patients, their initial degree of acidosis, dehydration, and systolic blood pressure, the insulin antibody characteristics of their sera, nor the rate of decline of the blood glucose.

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“…Comparing small doses of intramuscular insulin with intravenous insulin infusion or bolus therapy, the retrospective study by Soler found that intramuscular therapy sometimes resulted in delayed correction of hyperglycemia [12]. Soler also reported that low-dose therapy compared with high-dose bolus intravenous insulin therapy resulted in poor potassium retention, evident in the later hours of treatment [12]. Another randomized study of 30 patients treated with low-dose regimens accompanied by an initial loading bolus failed to show these differences between intramuscular and intravenous route [20].…”

Section: Route Of Administration Of Regular Insulin and Subcutaneous Usmentioning

confidence: 99%

“…It is also clear that, during treatment of DKA, the duration of insulin therapy necessary for resolution of ketonemia and acidosis is longer than the duration necessary for initial correction of hyperglycemia. An early report by Soler and colleagues showed that when intravenous insulin infusion was used for low-dose therapy, excluding cases in which bicarbonate was used, the time to correction of hyperglycemia (BG <250 mg/dl) was 5.8 ± 2.8 h, but the time to correct acido-± 2.8 h, but the time to correct acido-2.8 h, but the time to correct acidosis (HCO 3 >20 mmol/l) was 14.8 ± 8.3 h [12]. Once target-range glycemic control has been achieved, and when intravenous dextrose infusion commences, some authors describe a lower dose insulin infusion regimen or conversion to subcutaneous insulin to prevent relapsing ketogenesis and promote continued recovery from ketosis and acidosis.…”

Section: Continuation Of Insulin At a Reduced Rate After Initial Corrmentioning

confidence: 99%

A dose-defining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises

Devi¹,

Selvakumar²,

Clark³

et al. 2011

Diabetes Management

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Comparative Study of Different Insulin Regimens in Management of Diabetic Ketoacidosis

Cited by 69 publications

References 16 publications

Management of Hyperglycemic Crises in Patients With Diabetes

Management of Hyperglycemic Crises in Patients With Diabetes

Serum free insulin concentrations during the treatment of diabetic coma and precoma with low dose intramuscular insulin

A dose-defining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises

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