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Low- and High-Dose Intravenous Insulin Therapy for Diabetic Ketoacidosis FREE

Clicerio Gonzalez-Villalpando, MD; Jon D. Blachley, MD; George M. Vaughan, MD; Jan D. Smith, MD
[+] Author Affiliations

Reprint requests to Division of Endocrinology and Metabolism, Department of Internal Medicine, Michael Reese Hospital, 29th and Ellis Ave, Chicago, IL 60616 (Dr Gonzalez-Villalpando).


JAMA. 1979;241(9):925-927. doi:10.1001/jama.1979.03290350045023
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We compared low-dose, continuous insulin infusion with a conventional high-dose intravenous bolus method of insulin administration in 18 episodes of diabetic ketoacidosis. The average rate of reduction in serum glucose concentration was 9.5±3.8%/hr in the continuous infusion group and 10.7± 4.7%/hr in the bolus group. Arterial blood pH was corrected to 7.35 by 9.9±2.6/hours in the continuous infusion group and by 10.4±3.2/hours in the bolus group. The above means are not significantly different between groups. By the time pH was corrected to 7.35, patients in the continuous infusion group had received 121±44 units of insulin, whereas those in the bolus group had received 326±152 units. The continuous low-dose insulin infusion method is as safe and efficacious as the conventional high-dose intravenous bolus method.

(JAMA 241:925-927, 1979)

REFERENCES

Beigelman PM:  Severe diabetic ketoacidosis (diabetic "coma"): 482 episodes in 257 patients; experience of three years . Diabetes 20:490-500, 1971;.
Madison LL:  Low dose insulin: A plea for caution . N Engl J Med 294:393-394, 1976;.
Page MMcB, Alberti KGMM, Greenwood R, et al:  Treatment of diabetic coma with continuous low-dose infusion of insulin . Br Med J 2:687-690, 1974;.
Kidson W, Casey J, Kraegen E, et al:  Treatment of severe diabetes mellitus by insulin infusion . Br Med J 2:691-694, 1974;.
Semple PF, White C, Manderson NG:  Continuous intravenous infusion of small doses of insulin in treatment of diabetic ketoacidosis . Br Med J 2:694-698, 1974;.
Kitabchi AE, Ayyagari V, Guerra SO, et al:  The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis . Ann Intern Med 84:633-638, 1976;.
Heber D, Molitch ME, Sperling MA:  Lowdose continuous insulin therapy for diabetic ketoacidosis: Prospective comparison with conventional insulin therapy . Arch Intern Med 137:1377-1380, 1977;.
Ohman JL, Marliss EB, Aoki TT, et al:  The cerebrospinal fluid in diabetic ketoacidosis . N Engl J Med 284:283-290, 1971;.
Kreisberg RA:  Diabetic ketoacidosis: New concepts and trends in pathogenesis and treatment . Ann Intern Med 88:681-695, 1978;.
Fisher JN, Shashahani MN, Kitabchi AE:  Diabetic ketoacidosis: Low-dose insulin therapy by various routes . N Engl J Med 297:238-241, 1977;.
Padilla AJ, Loeb JN:  "Low dose" versus "high dose" insulin regimens in the management of uncontrolled diabetes . Am J Med 63:843-848, 1977;.
Peterson L, Caldwell J, Hoffman J:  Insulin adsorbance to polyvinyl chloride surfaces with implications for constant-infusion therapy . Diabetes 25:72-74, 1976;.

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Beigelman PM:  Severe diabetic ketoacidosis (diabetic "coma"): 482 episodes in 257 patients; experience of three years . Diabetes 20:490-500, 1971;.
Madison LL:  Low dose insulin: A plea for caution . N Engl J Med 294:393-394, 1976;.
Page MMcB, Alberti KGMM, Greenwood R, et al:  Treatment of diabetic coma with continuous low-dose infusion of insulin . Br Med J 2:687-690, 1974;.
Kidson W, Casey J, Kraegen E, et al:  Treatment of severe diabetes mellitus by insulin infusion . Br Med J 2:691-694, 1974;.
Semple PF, White C, Manderson NG:  Continuous intravenous infusion of small doses of insulin in treatment of diabetic ketoacidosis . Br Med J 2:694-698, 1974;.
Kitabchi AE, Ayyagari V, Guerra SO, et al:  The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis . Ann Intern Med 84:633-638, 1976;.
Heber D, Molitch ME, Sperling MA:  Lowdose continuous insulin therapy for diabetic ketoacidosis: Prospective comparison with conventional insulin therapy . Arch Intern Med 137:1377-1380, 1977;.
Ohman JL, Marliss EB, Aoki TT, et al:  The cerebrospinal fluid in diabetic ketoacidosis . N Engl J Med 284:283-290, 1971;.
Kreisberg RA:  Diabetic ketoacidosis: New concepts and trends in pathogenesis and treatment . Ann Intern Med 88:681-695, 1978;.
Fisher JN, Shashahani MN, Kitabchi AE:  Diabetic ketoacidosis: Low-dose insulin therapy by various routes . N Engl J Med 297:238-241, 1977;.
Padilla AJ, Loeb JN:  "Low dose" versus "high dose" insulin regimens in the management of uncontrolled diabetes . Am J Med 63:843-848, 1977;.
Peterson L, Caldwell J, Hoffman J:  Insulin adsorbance to polyvinyl chloride surfaces with implications for constant-infusion therapy . Diabetes 25:72-74, 1976;.
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