HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Umpierrez, G. E. Articles by Kitabchi, A. E. Search for Related Content PubMed PubMed Citation Articles by Umpierrez, G. E. Articles by Kitabchi, A. E. Social Bookmarking                What's this?

Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart

¹ Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
² University of Tennessee Health Sciences Center, Memphis, Tennessee

Address correspondence and reprint requests to Guillermo Umpierrez, MD, FACP, FACE, Associate Professor of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Dr., Atlanta, GA 30303. E-mail: geumpie{at}emory.edu

OBJECTIVE—In this prospective, randomized, open trial, we compared the efficacy and safety of aspart insulin given subcutaneously at different time intervals to a standard low-dose intravenous (IV) infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis (DKA).

RESEARCH DESIGN AND METHODS—A total of 45 consecutive patients admitted with DKA were randomly assigned to receive subcutaneous (SC) aspart insulin every hour (SC-1h, n = 15) or every 2 h (SC-2h, n = 15) or to receive IV infusion of regular insulin (n = 15). Response to medical therapy was evaluated by assessing the duration of treatment until resolution of hyperglycemia and ketoacidosis. Additional end points included total length of hospitalization, amount of insulin administration until resolution of hyperglycemia and ketoacidosis, and number of hypoglycemic events.

RESULTS—Admission biochemical parameters in patients treated with SC-1h (glucose: 44 ± 21 mmol/l [means ± SD], bicarbonate: 7.1 ± 3 mmol/l, pH: 7.14 ± 0.09) were similar to those treated with SC-2h (glucose: 42 ± 21 mmol/l, bicarbonate: 7.6 ± 4 mmol/l, pH: 7.15 ± 0.12) and IV regular insulin (glucose: 40 ± 13 mmol/l, bicarbonate 7.1 ± 4 mmol/l, pH: 7.11 ± 0.17). There were no statistical differences in the mean duration of treatment until correction of hyperglycemia (6.9 ± 4, 6.1 ± 4, and 7.1 ± 5 h) or until resolution of ketoacidosis (10 ± 3, 10.7 ± 3, and 11 ± 3 h) among patients treated with SC-1h and SC-2h or with IV insulin, respectively (NS). There was no mortality and no differences in the length of hospital stay, total amount of insulin administration until resolution of hyperglycemia or ketoacidosis, or the number of hypoglycemic events among treatment groups.

CONCLUSIONS—Our results indicate that the use of subcutaneous insulin aspart every 1 or 2 h represents a safe and effective alternative to the use of intravenous regular insulin in the management of patients with uncomplicated DKA.

Abbreviations: DKA, diabetic ketoacidosis • ICU, intensive care unit • IM, intramuscular • IV, intravenous • SC, subcutaneous • SC-1h, subcutaneous aspart insulin every hour • SC-2h, subcutaneous aspart insulin every 2 h

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				A. E. Kitabchi, G. E. Umpierrez, J. N. Fisher, M. B. Murphy, and F. B. Stentz Thirty Years of Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1541 - 1552. [Abstract] [Full Text] [PDF]

				N. B. Volkova, C. C. Fletcher, R. W. Tevendale, S. M. Munyaradzi, S. Elliot, and M. W. Peterson Impact of a Multidisciplinary Approach to Guideline Implementation in Diabetic Ketoacidosis American Journal of Medical Quality, February 1, 2008; 23(1): 47 - 55. [Abstract] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, M. B. Murphy, and R. A. Kreisberg Hyperglycemic Crises in Adult Patients With Diabetes: A consensus statement from the American Diabetes Association Diabetes Care, December 1, 2006; 29(12): 2739 - 2748. [Full Text] [PDF]

				J. Wolfsdorf, N. Glaser, and M. A. Sperling Diabetic Ketoacidosis in Infants, Children, and Adolescents: A consensus statement from the American Diabetes Association Diabetes Care, May 1, 2006; 29(5): 1150 - 1159. [Full Text] [PDF]

				T. Della Manna, L. Steinmetz, P. R. Campos, S. C.L. Farhat, C. Schvartsman, H. Kuperman, N. Setian, and D. Damiani Subcutaneous Use of a Fast-Acting Insulin Analog: An alternative treatment for pediatric patients with diabetic ketoacidosis Diabetes Care, August 1, 2005; 28(8): 1856 - 1861. [Abstract] [Full Text] [PDF]

				C. L. Thompson, K. C. Dunn, M. C. Menon, L. E. Kearns, and S. S. Braithwaite Hyperglycemia in the Hospital Diabetes Spectr, January 1, 2005; 18(1): 20 - 27. [Abstract] [Full Text] [PDF]