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The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis

Received: 13 April 2016     Accepted: 22 April 2016     Published: 11 May 2016
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Abstract

Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.

Published in American Journal of Internal Medicine (Volume 4, Issue 3)
DOI 10.11648/j.ajim.20160403.11
Page(s) 43-48
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Diabetes, Ketoacidosis, DKA, Insulin Pump, Continuous Subcutaneous Insulin Infusion

References
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[8] Vincent M, Nobécourt E. Treatment of diabetic ketoacidosis with subcutaneous insulin lispro: A review of the current evidence from clinical studies. Diabetes & metabolism. 2013; 39 (4): 299-305.
[9] Fisher JN, Shahshahani MN, Kitabchi AE. Diabetic ketoacidosis: low-dose insulin therapy by various routes. N Engl J Med 1977; 297: 238–241.
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[12] Latif K, Umpierrez GE, Stoever J, et al. Subcutaneous lispro insulin in the treatment of diabetic ketoacidosis. Diabetes 2003; 51 (Suppl. 2): 427.
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[21] Barski L, Kezerle L, Zeller L, et al. New approaches to the use of insulin in patients with diabetic ketoacidosis. Eur J Intern Med 2013; 24: 213-16.
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Cite This Article
  • APA Style

    Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. (2016). The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. American Journal of Internal Medicine, 4(3), 43-48. https://doi.org/10.11648/j.ajim.20160403.11

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    ACS Style

    Magui Abdel Moneim Shalash; Ali Ahmed Abdel Rahim; Kamel Hemida Rohoma; Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am. J. Intern. Med. 2016, 4(3), 43-48. doi: 10.11648/j.ajim.20160403.11

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    AMA Style

    Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am J Intern Med. 2016;4(3):43-48. doi: 10.11648/j.ajim.20160403.11

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  • @article{10.11648/j.ajim.20160403.11,
      author = {Magui Abdel Moneim Shalash and Ali Ahmed Abdel Rahim and Kamel Hemida Rohoma and Marwa Abdel Maaboud Elnabawy},
      title = {The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis},
      journal = {American Journal of Internal Medicine},
      volume = {4},
      number = {3},
      pages = {43-48},
      doi = {10.11648/j.ajim.20160403.11},
      url = {https://doi.org/10.11648/j.ajim.20160403.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160403.11},
      abstract = {Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis
    AU  - Magui Abdel Moneim Shalash
    AU  - Ali Ahmed Abdel Rahim
    AU  - Kamel Hemida Rohoma
    AU  - Marwa Abdel Maaboud Elnabawy
    Y1  - 2016/05/11
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    N1  - https://doi.org/10.11648/j.ajim.20160403.11
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    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 43
    EP  - 48
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20160403.11
    AB  - Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.
    VL  - 4
    IS  - 3
    ER  - 

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Author Information
  • Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

  • Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

  • Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

  • Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

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