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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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Changes in hourly serum potassium with three low-dose insulin regimens in the treatment of DKA.
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f2: Changes in hourly serum potassium with three low-dose insulin regimens in the treatment of DKA.

Mentions: Table 3 demonstrates the outcome recovery data for DKA, depicting the time that predetermined values were reached for glucose, HCO3−, and pH. The results suggested no significant differences in these values for the three doses of insulin, but 5 of 12 patients in the no load group required additional insulin for control of their blood glucose. The length of hospitalization was not significantly different among the groups, there were no complications in any of the groups, and no deaths occurred in this cohort. No hypokalemia was noted in any treatment group. The potassium nadirs were 4.3, 4.2, and 3.7 mEq/l in the load, no load, and twice no load groups, respectively (Fig. 2).


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)

Changes in hourly serum potassium with three low-dose insulin regimens in the treatment of DKA.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Changes in hourly serum potassium with three low-dose insulin regimens in the treatment of DKA.
Mentions: Table 3 demonstrates the outcome recovery data for DKA, depicting the time that predetermined values were reached for glucose, HCO3−, and pH. The results suggested no significant differences in these values for the three doses of insulin, but 5 of 12 patients in the no load group required additional insulin for control of their blood glucose. The length of hospitalization was not significantly different among the groups, there were no complications in any of the groups, and no deaths occurred in this cohort. No hypokalemia was noted in any treatment group. The potassium nadirs were 4.3, 4.2, and 3.7 mEq/l in the load, no load, and twice no load groups, respectively (Fig. 2).

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