Evaluation of Early Administration of Insulin Glargine in the Acute Management of Diabetic Ketoacidosis

2021 ◽  
Vol 17 ◽  
Author(s):  
Adham Mohamed ◽  
Jeannette Ploetz ◽  
Majdi S Hamarshi
Keyword(s):  
Insulin Glargine ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Acute Management ◽  
Early Administration ◽  
Intravenous Insulin ◽  
Serum Bicarbonate Level ◽  
The Mean ◽  
Mean Blood Glucose

Background: Few studies have evaluated the early use of insulin glargine in the management of diabetic ketoacidosis (DKA) patients. Early insulin glargine use in DKA was safe and associated with a trend towards faster DKA resolution. Objectives: To evaluate the efficacy and safety of early insulin glargine administration for acute management of DKA in critically ill patients. Methods: This single-center retrospective cohort study included patients, who were >18 years of age with DKA, admitted to the intensive care unit (ICU) for at least 12 h, and received intravenous insulin infusion for at least 6 h. The primary endpoint was the association between the time to insulin glargine administration and time to DKA resolution. Linear and logistic regression analyses were performed. Results: Of the 913 patients evaluated, 380 were included in the study. The overall mean age was 45±17 years, 196 (51.6%) were female, and 262 (70%) patients had type 1 diabetes mellitus. The mean blood glucose level was 584.9±210 mg/dL, pH was 7.16±0.17, anion gap was 28.17±6.9 mEq/L, and serum bicarbonate level was 11.19±5.72 mEq/L. Every 6-h delay in insulin glargine administration was associated with a 26-min increase in time to DKA resolution (95% confidence interval [CI], 14.76–37.44; p<0.0001), 3.2-h increase in insulin infusion duration (95% CI, 28.8–36; p<0.0001), and 6.5-h increase in ICU LOS (95% CI, 5.04–7.92; p<0.0001). Conclusion: Early administration of insulin glargine is potentially safe and may be associated with a reduction in time to DKA resolution and shorter duration of insulin infusion.

scholarly journals Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

BMJ ◽  
2019 ◽  
pp. l1114 ◽  
Author(s):  
Esra Karslioglu French ◽  
Amy C Donihi ◽  
Mary T Korytkowski
Keyword(s):  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Hospital Readmissions ◽  
Acute Management ◽  
Careful Monitoring ◽  
Acute Presentation ◽  
Intravenous Insulin ◽  
Patients With Diabetes ◽  
Life Threatening ◽  
Hyperosmolar Hyperglycemic Syndrome

Abstract Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

Utilizing serum bicarbonate instead of venous pH to transition from intravenous to subcutaneous insulin shortens the duration of insulin infusion in pediatric diabetic ketoacidosis

2019 ◽  
Vol 32 (1) ◽  
pp. 11-17
Author(s):  
Jennifer Gauntt ◽  
Priya Vaidyanathan ◽  
Sonali Basu
Keyword(s):  
Adverse Events ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Regular Insulin ◽  
Serum Bicarbonate ◽  
Transition Group ◽  
Serum Bicarbonate Level ◽  
Transition Criteria

Abstract Background Standard therapy of diabetic ketoacidosis (DKA) in pediatrics involves intravenous (IV) infusion of regular insulin until correction of acidosis, followed by transition to subcutaneous (SC) insulin. It is unclear what laboratory marker best indicates correction of acidosis. We hypothesized that an institutional protocol change to determine correction of acidosis based on serum bicarbonate level instead of venous pH would shorten the duration of insulin infusion and decrease the number of pediatric intensive care unit (PICU) therapies without an increase in adverse events. Methods We conducted a retrospective (pre/post) analysis of records for patients admitted with DKA to the PICU of a large tertiary care children’s hospital before and after a transition-criteria protocol change. Outcomes were compared between patients in the pH transition group (transition when venous pH≥7.3) and the bicarbonate transition group (transition when serum bicarbonate ≥15 mmol/L). Results We evaluated 274 patient records (n=142 pH transition group, n=132 bicarbonate transition group). Duration of insulin infusion was shorter in the bicarbonate transition group (18.5 vs. 15.4 h, p=0.008). PICU length of stay was 3.2 h shorter in the bicarbonate transition group (26.0 vs. 22.8 h, p=0.04). There was no difference in the number of adverse events between the groups. Conclusions Transitioning patients from IV to SC insulin based on serum bicarbonate instead of venous pH led to a shorter duration of insulin infusion with a reduction in the number of PICU therapies without an increase in the number of adverse events.

Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia

2022 ◽  
pp. 106002802110701
Author(s):  
Francisco Ibarra ◽  
Kaitlyn Loi ◽  
Ann W. Vu
Keyword(s):  
Medical History ◽  
Insulin Infusion ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Acute Management ◽  
Past Medical History ◽  
Safety And Efficacy ◽  
Intravenous Insulin ◽  
Number Of Patients ◽  
History Of

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.

scholarly journals Effect of Different Insulin Therapies on Obstetric-Fetal Outcomes

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Cristina López-Tinoco ◽  
José Luis Jiménez-Blázquez ◽  
Laura Larrán-Escandón ◽  
María del Mar Roca-Rodríguez ◽  
Fernando Bugatto ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Infusion ◽  
Insulin Analogues ◽  
Fetal Outcomes ◽  
Pregestational Diabetes ◽  
Acting Insulin ◽  
Short Acting Insulin ◽  
Neutral Protamine Hagedorn ◽  
The Mean

AbstractTo evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus. We enrolled 147 pregnant women with pre-existing type 1 or 2 diabetes mellitus. Clinical and biochemical parameters were analysed in relation to obstetric and fetal outcomes. 14.2% received treatment with Neutral Protamine Hagedorn insulin and short-acting insulin analogues; 19% with premixed human insulin; 40.1% with insulin glargine and lispro, 6.2% with detemir and aspart and 20% with continuous subcutaneous insulin infusion. All 5 types of treatment achieved a reduction of the mean HbA1c during pregnancy (p = 0.01). Pre-pregnancy care was carried out for 48% of patients. We found no statistically significant differences between the different insulin therapies and the obstetric-fetal outcomes. In conclusión, the different insulin therapies used in patients with pregestational diabetes mellitus does not seem to affect obstetric-fetal outcomes.

Effectiveness of low-dose continuous intravenous insulin infusion in diabetic ketoacidosis

1977 ◽  
Vol 91 (5) ◽  
pp. 701-705 ◽  
Author(s):  
George A. Edwards ◽  
Edward C. Kohaut ◽  
Barbara Wehring ◽  
L. Leighton Hill
Keyword(s):  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Low Dose ◽  
Intravenous Insulin
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