Efficacy and Safety of Intramuscular Insulin Lispro vs. Continuous Intravenous Regular Insulin for the Treatment of Dogs With Diabetic Ketoacidosis

Background: Human regular insulin 500 (U-500) is 5 five times more concentrated than the traditional regular human insulin (U-100). Thus, every 1 ml of U-500 contains 500 units of insulin as opposed to 100 units/ml with most types of insulin. Methods: Review of all the relevant clinical studies related to insulin U-500 until February 12, 2020. Results: Insulin U-500 is indicated in patients with type 2 diabetes who require more than 200 units of insulin per day. Insulin U-500 has both prandial and basal actions, and can be injected as monotherapy in a convenient twice-daily regimen. Available data suggest that insulin U-500 is effective, associated with better compliance, and decreased injection pain compared with non-concentrated insulins. Its main limitations are hypoglycemia and weight gain, and the possibility of dosing errors. Conclusions: Overall, insulin U-500 is an effective and safe treatment for patients with type 2 diabetes and insulin resistance. Randomized trials are needed to compare the long-term efficacy and safety of insulin U-500 with other forms of insulin regimens.

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Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Journal of Veterinary Emergency and Critical Care ◽

10.1111/vec.13062 ◽

2021 ◽

Author(s):

Florian K. Zeugswetter ◽

Nicole Luckschander‐Zeller ◽

Sonja Karlovits ◽

Jaquie S. Rand

Keyword(s):

Diabetic Ketoacidosis ◽

Regular Insulin

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Higher-Than-Conventional Subcutaneous Regular Insulin Doses in Diabetic Ketoacidosis in Children and Adolescents

Journal of Clinical Research in Pediatric Endocrinology ◽

10.4274/jcrpe.3925 ◽

2017 ◽

Vol 9 (2) ◽

pp. 132-137

Author(s):

Özlem Bağ ◽

Selma Tunç ◽

Özlem Nalbantoğlu ◽

Çiğdem Ecevit ◽

Aysel Öztürk ◽

...

Keyword(s):

Children And Adolescents ◽

Diabetic Ketoacidosis ◽

Regular Insulin

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

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0394 ◽

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.

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