Summary
Twenty-six diabetic ketoacidotic patients were treated with 3 different intravenous insulin regimes. Group (A) received 50 U initially and at 2 h intervals. Groups (B) and (C) were given continuous infusions of 10 and 2 U per hour respectively without added albumin. In addition, Group (C) received a loading dose of 3 U. The dosages were reduced when serum glucose declined to 300 mg/100 ml. Criteria for admission to the study included a plasma glucose above 350 mg/100 ml, plasma bicarbonate less than 9 mmol/l, serum ketone-bodies detectable by nitroprusside test at 8-fold or greater dilution, and arterial pH less than 7.3. The rate of normalization of blood glucose, bicarbonate, ketone bodies, and pH did not differ between Group (A) and (B). In contrast, the changes in pH, glucose, and ketone-bodies were significantly slower in Group (C). Two patients of Group (C) had worsening of these biochemical parameters during the first 6 h. They were treated successfully with regimen A. At 2 h, plasma immunoreactive insulin concentrations were 47±15, 135±19, and 25±3 μU/ml in previously untreated patients in Groups (A), (B) and (C), respectively. Potassium requirements to maintain adequate blood levels were significantly higher in Group (A). The data demonstrate that 10 U/h infusion of insulin is as effective as 50 U administered intravenously every 2 h. The amount of insulin infused should be reduced to 5 U/h when plasma glucose has declined to 300 mg/100 ml. The recovery is slow, plasma insulin concentration is inadequate and treatment failure may occur with very low insulin doses (2 U/h).
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References
Felig, P.: Diabetic ketoacidosis. N. Engl. J. Med.290, 1365–1369 (1974)
Genuth, S.M.: Constant intravenous insulin infusion in diabetic ketoacidosis. J. A. M. A.233, 1348–1351 (1973)
Hockaday, T.D.R., Alberti, K.G.M.M: Diabetic coma. Clin. Endocrinol. Metabol.1, 751–788 (1972)
Winegrad, A.I., Clements, R.S.: Diabetic ketoacidosis. Med. Clin. North Am.55, 899–911 (1971)
Shaw, C.S., Hurwitz, G.E., Schmukler, M., Brager, S.H., Bessman, S.P.: A clinical and laboratory study of insulin dosage in diabetic acidosis: Comparison with small and large doses. Diabetes11, 23–30 (1962)
Smith, K., Martin, H.E.: Responses of diabetic coma to various insulin dosages. Diabetes3, 287–295 (1954)
Sönksen, P.H., Srivastava, M.C., Tompkins, C.V., Nabarro, J. D.N.: Growth hormone and cortisol responses to insulin infusion in patients with diabetes mellitus. Lancet1972 II, 155–160
Alberti, K.G.M.M., Hockaday, T.D., Turner, R.C.: Small doses of intramuscular insulin in the treatment of diabetic “coma”. Lancet1973 II, 515–522
Semple, P.F., White, C., Manderson, W.G.: Continuous intravenous infusion of small doses of insulin in the treatment of diabetic ketoacidosis. Br. Med. J.1974 II, 694–698
Kidson, W., Casey, J., Kraegen, E., Lazarus, L.: Treatment of severe diabetes mellitus by insulin infusion. Br. Med. J.1974 II, 691–694
Page, M.McB., Alberti, K.G.M.M., Greenwood, R., Gumaa, K.A., Hockaday, T.D.R., Lowy, C., Nabarro, J.D.N., Pyke, D.A., Sönksen, P.H., Watkins, P.J., West, T.E.T.: Treatment of diabetic coma with continuous low-dose infusion of insulin. Br. Med. J.1974 II, 687–690
Madison, L.L.: Low dose insulin: A plea for caution. N. Engl. J. Med.294, 393–394 (1976)
Kitabchi, A.E., Ayyagari, V., Guerra, S. M. O., Medical House Staff: The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Ann. Intern. Med.84, 633–638 (1976)
Hales, C.N., Randle, P.J.: Assay of insulin with insulin antibody precipitate. Biochem. J.88, 137–146 (1963)
Bessman, S.P., Anderson, M.: Estimation of citric acid and ketone bodies by the salicylaldehyde acetone reaction. Fed. Proc.16, 154 (1957)
Clumeck, N., Troyer, A.D., Naeije, R., Somers, G., Smekens, L., Balasse, E.O.: Treatment of diabetic coma with small intravenous insulin boluses. Br. Med. J.1976 II, 394–396
Lundbaek, K., Christensen, S.E., Hansen, Aa.P., Iversen, J., Ørskov, H., Seyer-Hensen, K., Alberti, K.G.M.M., Whitefoot, R.: Failure of somatostatin to correct manifest diabetic ketoacidosis. Lancet1976 I, 215–218
Lavis, V.R., Ensinck, J.W., Williams, R.H.: Effects of insulin and proinsulin on isolated fat cells and hemidiaphragms from rats. Endocrinology87, 135–42 (1970)
Horwitz, D.L., Starr, J.I., Mako, M.E., Blackard, W.G., Rubenstein, A.H.: Proinsulin, insulin and C-peptide concentrations in human portal and peripheral blood. J. Clin. Invest.55, 1278–1283 (1975)
Felig, P., Wahren, J.: Influence of endogenous insulin secretion on splanchnic glucose and amino acid metabolism in man. J. Clin. Invest.50, 1702–1711 (1971)
Soler, N.G., Wright, A.D., Fitzgerald, M.G., Malins, J.M.: Comparative study of different insulin regimens in management of diabetic ketoacidosis. Lancet1975 II, 1221–1224
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Piters, K.M., Kumar, D., Pei, E. et al. Comparison of continuous and intermittent intravenous insulin therapies for diabetic ketoacidosis. Diabetologia 13, 317–321 (1977). https://doi.org/10.1007/BF01223272
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DOI: https://doi.org/10.1007/BF01223272