Summary
Patients with severe diabetic ketoacidosis (pH<7.10) were treated according to two protocols. Protocol I consisted of high-dose insulin therapy by intravenous and intramuscular injections and bicarbonate infusion and was used in the first 12 patients; they received an average of 260 U insulin and 167 mmol bicarbonate in the first 6 h of treatment. Protocol II consisted of low-dose continuous intravenous insulin therapy, 8 U/hour, without bicarbonate in a further 12 patients. Rehydration and potassium-supplementation were the same in both methods. Basal data of both groups were not significantly different. The fall of plasma glucose concentration, rise in arterial pH and decrease in 3-hydroxy-butyrate were similar in the two groups. The mean time to achieve a pH ⩾ 7.30 was 6.8 hours in the high-dose group and 7.6 hours in the low-dose group (p>0.10). Potassium supplementation and potassium concentration during both treatments were the same. During the low-dose treatment the mean (±SD) plasma insulin concentration was 121±46 μU/ml. The presence of insulin binding antibodies did not result in lower free insulin concentrations. Thus, in the treatment of severe ketoacidosis continuous intravenous therapy with low-dose insulin is as effective as high-dose therapy and bicarbonate-adminis-tration is probably unnecessary.
Article PDF
Similar content being viewed by others
References
Albert, K. G. M. M., Hockaday, T. D. R., Turner, R. C.: Small doses of intramuscular insulin in the treatment of diabetic “coma”. Lancet1973 II, 515–522
Page, M. M., 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
Kidson, W., Casey, J., Kreagen, E., Lazarus, L.: Treatment of severe diabetes mellitus by insulin infusion. Br. Med. J.1974 II, 691–694
Semple, P. E., White, C., Manderson, W. G.: Continuous intravenous infusion of small doses insulin in treatment of diabetic ketoacidosis. Br. Med. J.1974 II, 694–698
Moseley, J.: Diabetic crises in children treated with small doses of intramuscular insulin. Br. Med. J.1975 I, 59–61
Soler, N. G., FitzGerald, M. G., Wright, A. D., Malins, J. M.: Comparative study of different insulin regimens in management of diabetic ketoacidosis. Lancet1975 II, 1221–1224
Clumeck, N., de Troyer, A., Naeije, R., Somers, G., Smekens, L., Balasse, E. D.: Treatment of diabetic coma with small intravenous insulin boluses. Br. Med. J.1976 II, 394–396
Hannan, T. J., Stathers, G. M.: Constant low-dose insulin infusion in severe diabetes mellitus. Med. J. Aust.1976 I, 11–13
Kitabchi, A. E., Ayyagari, V., Guerra, S. M., 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)
Fisher, J. N., Shahshahani, M. N., Kitabchi, A. E.: Diabetic Ketoacidosis: Low-dose insulin therapy by various routes. N. Engl. J. Med.297, 238–241 (1977)
Piters, K. M., Kumar, D., Pei, E., Bessman, A. N.: Comparison of continuous and intermittent intravenous insulin therapies for diabetic ketoacidosis. Diabetologia13, 317–321 (1977)
Heber, D., Molitch, M. E., Sperling, M. A.: Low-dose continuous insulin therapy for diabetic ketoacidosis. Prospective comparison with “conventional” insulin therapy. Arch. Intern. Med.137, 1377–1380 (1977)
Hoffman, W. S.: A rapid photoelectric method for the determination of glucose in blood and urine. J. Biol. Chem.120, 51–55 (1937)
Mellanby, J., Williamson, D. M.: In: Methoden der enzymatischen Analyse. Bergmeyer, H. E. (Ed.) — pp 1883–1886. Weinheim/Bergstr.: Verlag Chemie 1974
Hollander, F. D. den, Schuurs, A. H. W. M., Hell, H. van: Radioimmunoassays for human gonadotrophins and insulin employing a “double-antibody solid-phase” technique. J. Immunol. Methods1972 I, 247–262
Nakagawa, S., Nakayama, H., Sasaki, T., Yochino, K., Yu, Y. Y., Shinozaki, K., Aoki, S., Hashimo, K.: A simple method for the determination of serum free insulin levels in insulintreated patients. Diabetes22, 590–600 (1973)
Christensen, N. J., Ørskov, H.: The relation between endogenous serum insulin concentration and glucose uptake in the forearm muscles of non diabetics. J. Clin. Invest.47, 1262–1268 (1968)
Schade, D. S., Eaton, Ph.: Dose response to insulin in man: differential effects on glucose and ketone body regulation. J. Clin. Endocrinol. Metab.44, 1038–1053 (1977)
Brown, P. M., Tompkins, C. V., Juul, S., Sönksen, P. H.: Mechanism of action of insulin in diabetic patients: a doserelated effect on glucose production and utilisation. Br. Med. J.1978 I, 1239–1242
Asplin, C. M., Hartog, M.: Serum free insulin concentrations during the treatment of diabetic coma and precoma with low dose intramuscular insulin. Diabetologia13, 475–480 (1977)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lutterman, J.A., Adriaansen, A.A.J. & van 't Laar, A. Treatment of severe diabetic ketoacidosis. Diabetologia 17, 17–21 (1979). https://doi.org/10.1007/BF01222972
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF01222972