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Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis?

Kitabchi AE, Murphy MB, Spencer J, Matteri R, Karas J - Diabetes Care (2008)

Bottom Line: Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA.Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not.Except for these differences, times to reach glucose <or=250 mg/dl, pH >or=7.3, and HCO(3)(-) >or=15 mEq/l did not differ significantly among the three groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Molecular Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA. akitabchi@utmem.edu

ABSTRACT

Objective: The purpose of this study was to assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous infusions without a priming dose.

Research design and methods: This prospective randomized protocol used three insulin therapy methods: 1) load group using a priming dose of 0.07 units of regular insulin per kg body weight followed by a dose of 0.07 unit x kg(-1) x h(-1) i.v. in 12 patients with diabetic ketoacidosis (DKA); 2) no load group using an infusion of regular insulin of 0.07 unit . kg body weight(-1) x h(-1) without a loading dose in 12 patients with DKA, and 3) twice no load group using an infusion of regular insulin of 0.14 x kg(-1) x h(-1) without a loading dose in 13 patients with DKA. Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA.

Results: The load group reached a peak in free insulin value (460 microU/ml) within 5 min and plateaued at 88 microU/ml in 60 min. The twice no load group reached a peak (200 microU/ml) at 45 min. The no load group reached a peak (60 microU/ml) in 60-120 min. Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not. Except for these differences, times to reach glucose or=7.3, and HCO(3)(-) >or=15 mEq/l did not differ significantly among the three groups.

Conclusions: A priming dose in low-dose insulin therapy in patients with DKA is unnecessary if an adequate dose of regular insulin of 0.14 unit x kg body weight(-1) x h(-1) (about 10 units/h in a 70-kg patient) is given.

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Kinetics of three doses of low-dose insulin in patients with DKA.
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f1: Kinetics of three doses of low-dose insulin in patients with DKA.

Mentions: Figure 1 demonstrates the kinetics of intravenous insulin after infusion in the three arms. This figure shows that infusion of insulin of 0.07 (no load) or 0.14 unit · kg−1 · h−1 (twice no load) without an initial bolus resulted in peaks of 66 and 202 μU/ml, respectively, whereas the use of an intravenous bolus of 0.07 unit/kg followed by a 0.07 unit · kg−1 · h−1 infusion resulted in peak insulin of ∼460 μU/ml at 5 min, which reached a plateau level of ∼86 μU/ml in 30 min. It is also of interest that plateau levels of insulin for both the load and no load groups are not significantly different from 60 to 120 min. However, the twice no load group (0.14 unit · kg−1 · h−1, which is ∼10 units/h of insulin in a 70-kg patient) maintained higher levels of insulin during 30–120 min of infusion than those of the load or no load group.


Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis?

Kitabchi AE, Murphy MB, Spencer J, Matteri R, Karas J - Diabetes Care (2008)

Kinetics of three doses of low-dose insulin in patients with DKA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571050&req=5

f1: Kinetics of three doses of low-dose insulin in patients with DKA.
Mentions: Figure 1 demonstrates the kinetics of intravenous insulin after infusion in the three arms. This figure shows that infusion of insulin of 0.07 (no load) or 0.14 unit · kg−1 · h−1 (twice no load) without an initial bolus resulted in peaks of 66 and 202 μU/ml, respectively, whereas the use of an intravenous bolus of 0.07 unit/kg followed by a 0.07 unit · kg−1 · h−1 infusion resulted in peak insulin of ∼460 μU/ml at 5 min, which reached a plateau level of ∼86 μU/ml in 30 min. It is also of interest that plateau levels of insulin for both the load and no load groups are not significantly different from 60 to 120 min. However, the twice no load group (0.14 unit · kg−1 · h−1, which is ∼10 units/h of insulin in a 70-kg patient) maintained higher levels of insulin during 30–120 min of infusion than those of the load or no load group.

Bottom Line: Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA.Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not.Except for these differences, times to reach glucose <or=250 mg/dl, pH >or=7.3, and HCO(3)(-) >or=15 mEq/l did not differ significantly among the three groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Molecular Sciences, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA. akitabchi@utmem.edu

ABSTRACT

Objective: The purpose of this study was to assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous infusions without a priming dose.

Research design and methods: This prospective randomized protocol used three insulin therapy methods: 1) load group using a priming dose of 0.07 units of regular insulin per kg body weight followed by a dose of 0.07 unit x kg(-1) x h(-1) i.v. in 12 patients with diabetic ketoacidosis (DKA); 2) no load group using an infusion of regular insulin of 0.07 unit . kg body weight(-1) x h(-1) without a loading dose in 12 patients with DKA, and 3) twice no load group using an infusion of regular insulin of 0.14 x kg(-1) x h(-1) without a loading dose in 13 patients with DKA. Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA.

Results: The load group reached a peak in free insulin value (460 microU/ml) within 5 min and plateaued at 88 microU/ml in 60 min. The twice no load group reached a peak (200 microU/ml) at 45 min. The no load group reached a peak (60 microU/ml) in 60-120 min. Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not. Except for these differences, times to reach glucose or=7.3, and HCO(3)(-) >or=15 mEq/l did not differ significantly among the three groups.

Conclusions: A priming dose in low-dose insulin therapy in patients with DKA is unnecessary if an adequate dose of regular insulin of 0.14 unit x kg body weight(-1) x h(-1) (about 10 units/h in a 70-kg patient) is given.

Show MeSH
Related in: MedlinePlus