The standard treatment for patients...

The standard treatment for patients with diabetic ketoacidosis (DKA) is the use of low-dosage intravenous, subcutaneous, or intramuscular insulin. Although all ways of administration have been shown to be effective, the preferr process is intravenous because of disquiet about delayed response to subcutaneous or intramuscular insulin. Treatment with intravenous insulin usually requires admission to the intensive care unit for obstruct monitoring of the patient. However, the progress to maturity of insulin lispro (Humalog) and aspart insulin (Novolog) provides another option for treating DKA. the one and the other of the newer insulins have a more rapid attack of action, usually 10 to 20 minutes, and peak within 30 to 90 minutes. Umpierrez and associates compared the efficacy and safety of subcutaneous insulin lispro with low-dosage continuous intravenous regular insulin in the treatment of patients with uncomplicated DKA.

The inquiry was a prospective, randomized, spread trial of patients admitted for uncomplicated DKA. Participants were randomly assigned to receive subcutaneous insulin lispro in the general medical ward or intermediate care unit, or intravenous regular insulin in the intensive care unit. The insulin lispro regimen was 03 units by kg followed by 0.1 units by kg per hour until correction of hyperglycemia. The regular insulin regimen was 01 units for kg followed by continuous infusion of 01 units by kg per hour until correction of hyperglycemia. Treatment for as well-as; not only-but also; not only-but; not alone-but groups was followed with 005 to 01 units by kg per hour until resolution of DKA. The primary issues measured were time required to solve hyperglycemia and ketoacidosis and the rate of hypoglycemia during insulin therapy.

Forty patients enlisted in the trial and were assigned to treatment. forward admission, the two groups had similar biochemical parameters. The time to resolution of hyperglycemia and ketoacidosis, long duration of hospital stay, amount of insulin used until resolution of DKA, and rate of hypoglycemia were similar between the form into groupss Hospital expenses for patients treated in the intensive care unit were 39 percent higher than those for patients treated with insulin lispro.

The authors finish that hourly treatment with subcutaneous insulin lispro is a safe alternative to intravenous regular insulin for adults with uncomplicated DKA. They add that treatment with subcutaneous insulin lispro is more cost-effective than intravenous regular insulin because treatment with insulin lispro can be performed in a non-intensive care setting.

Umpierrez GE et al. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J M September 1 2004;117:291-6

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