Is A Priming Dose Of Insulin Necessary In A Low Dose Insulin Protocol For The Treatment Of Diabetic Ketoacidosis?

Abstract

Objective: To assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous doses without priming.

Research Design and Method: This prospective randomized protocol used three insulin therapy methods: A) Load group using a priming dose of 0.07U regular insulin/kg body weight (Bwt) followed by a dose of 0.07U/kg/h intravenously in 12 DKA patients; B) No load group using an insulin infusion of 0.07U regular insulin/kg Bwt/h in 12 DKA patients; and C) Twice no load group using an insulin infusion of 0.14U regular insulin/kg/h without a loading dose in 13 DKA patients. 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 (460μU/ml) within five minutes and plateaued at 88 μU/ml in sixty minutes. The Twice No Load group reached a peak (200 μU/ml) at 45 minutes. The No Load group reached peak (60 μU/ml) in 60-120 minutes. Five patients in the No Load group required supplemental insulin doses to decrease initial glucose levels by 10%, the Twice No Load and Load groups did not. Except for these differences, times to reach glucose ≤ 250 mg/dl, pH ≥7.3 and HCO3>15meq/L did not differ significantly among the three groups.

Conclusion: A priming dose in low-dose insulin therapy in DKA patients is unnecessary if using an adequate dose of 0.14U of regular insulin per kg/Bwt/h (about 10U/h in a 70kg patient).