Effectiveness and safety of early insulin glargine administration in combination with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial

Abstract

Aim: To determine the effectiveness and safety of early combination of insulin glargine with intravenous (IV) insulin infusion compared with IV insulin infusion alone in the management of diabetic ketoacidosis (DKA).Methods: This was a single-centre, open-label, randomized controlled trial of adults aged 18 years or older diagnosed with DKA. The 'early glargine' group was given subcutaneous insulin glargine 0.3 units/kg within the first 3 hours of DKA diagnosis, in addition to the standard IV insulin infusion. The control group received standard IV insulin treatment only. The primary outcome was the time to DKA resolution. The other outcomes included rebound hyperglycaemia, mortality, hypoglycaemia and hypokalaemia, as well as the length of hospital stay (LOS).Results: A total of 60 patients (30 patients per group) were enrolled. Most patients (76.7%) had type 2 diabetes. Both groups were similar in baseline characteristics, except for higher serum beta-hydroxybutyrate and lower pH levels in the early glargine group. The mean ± standard deviation time to DKA resolution in the early glargine group was significantly faster than the control group (9.89 ± 3.81 vs. 12.73 ± 5.37 hours; P = .022). The median (interquartile range) LOS was significantly shorter in the early glargine group than in the control group (4.75 [3.53-8.96] vs. 15.25 [5.71-26.38] days; P = .024). The incidence of rebound hyperglycaemia, allcause mortality, hypoglycaemia and hypokalaemia was similar between the groups.Conclusions: Early combination of insulin glargine with IV insulin infusion led to a faster DKA resolution and a shorter LOS, without increasing hypoglycaemia and hypokalaemia.

Evaluation of the Effects of Incorporating Long-Acting Subcutaneous Insulin Into the Standard Treatment Protocol for Diabetic Ketoacidosis in Children

“…Importantly, this intervention did not lead to an increase in side effects. This information is supported by another study (21).…”

“…insulin has not been explored in any of these studies. Two articles with similar findings have focused on children within a specific age range (12,17); however, other studies have been conducted in the adolescent or adult age group (18)(19)(20)(21).…”

Between Medicines and Nutraceuticals in the Control of Diabetes Mellitus

“…Examples include insulin lispro, insulin aspart(NovoLog, NovoLog FlexPen, NovoPen Echo, NovoLog FlexTouch, Fiasp), and insulin glulisine(Lantus, Basaglar, Toujeo, Semglee, and Rezvoglar) 5 .Rapid-acting insulin is the type of insulin that was used to control blood sugar after meals before ultra-rapid-acting insulin became available, such as regular insulin. It usually takes effect 30 minutes to an hour after administration, and its effects usually last two to four hours.Intermediate-type insulin (NPH insulin) takes effect one to three hours after administration, with a duration of action of 12 to 16 hours and a peak effect of 6 to 8 hours after administration 6 .Long-acting insulins include insulin glargine, insulin detemir(Levemir), and degludec(Tresiba), which have a longer duration of action and more consistent effects than intermediate insulins, and are often used as basal insulin 7 .For type 2 diabetes, the treatment is based on lifestyle modification and may require additional medication. These medications are taken one to three times a day and have different dosing schedules and side effects depending on their duration of action 8 .…”

Hyperglycaemic crises in adults with diabetes: a consensus report

“…The administration of basal insulin while on fixed-rate intravenous insulin infusion is advocated by many clinicians but avoided by others because of the risk of hypoglycaemia [134] or hypokalaemia [135]. Several studies have reported that the coadministration of a low dose (0.15-0.3 U/kg) of basal insulin during insulin infusion reduces time to DKA resolution, duration of insulin infusion [136,137] and length of hospital stay [136] and prevents rebound hyperglycaemia, all without increased risk of hypoglycaemia [136,138,139].…”