Despite available methods of monitoring the clinical and metabolic state of a diabetic in ketoacidotic coma, uncertainties remain about the optimum dosage of required insulin and the frequency of its administration. Even though the half-life of subcutaneously injected insulin is known to be four to five hours, its absorption rate in ketoacidotic coma is often unpredictable. Equally unforeseeable are the vagaries of absorption by way of the intramuscular route. Added to these imponderables is apprehension that insulin may become less effective as coma deepens.
Recent reports suggest that much uncertainty can be eliminated by continuous low-dose intravenous infusion of insulin. First reported by Sönksen1 in 1972, this approach has been tried recently in several medical centers. Three reports, published in the June 29 issue of the British Medical Journal, attest to its success.
From England comes the report of a collaborative project of four hospitals.2 Thirty-eight comatose diabetics