scholarly journals A Pediatric Diabetic Ketoacidosis Management Protocol Incorporating a Two-Bag Intravenous Fluid System Decreases Duration of Intravenous Insulin Therapy

2016 ◽  
Vol 21 (6) ◽  
pp. 512-517 ◽  
Author(s):  
Megan Veverka ◽  
Kourtney Marsh ◽  
Susan Norman ◽  
Michael Alan Brock ◽  
Monica Peng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Diabetic Ketoacidosis ◽  
Median Number ◽  
Process Efficiency ◽  
Fluid System ◽  
Intravenous Insulin ◽  
Management Protocol

OBJECTIVES: Diabetic ketoacidosis (DKA) is a leading cause of morbidity and mortality in children with type 1 diabetes. We implemented a standardized DKA management protocol by using a 2-bag intravenous (IV) fluid system. The purpose of the study was to examine if the protocol improved clinical outcomes and process efficiency. METHODS: This was a retrospective study of patients who did and did not undergo the protocol. Patients were included if they were 18 years of age or younger, were diagnosed with DKA, admitted to an intensive care unit or stepdown unit, and received continuous IV insulin. RESULTS: Of 119 encounters evaluated, 46 (38.7%) received treatment with the protocol and 73 (61.3%) did not. The median time to normalization of ketoacidosis was 9 hours (IQR 5–12) and 9 hours (IQR 6.5–13) for protocol and non-protocol groups, respectively (p = 0.14). The median duration of IV insulin therapy was 16.9 hours (IQR 13.7–21.5) vs. 21 hours (IQR 15.3–26) for protocol and non-protocol groups (p = 0.03). The median number of adjustments to insulin drip rate was 0 (IQR 0–1) and 2 (IQR 0–3) for protocol and non-protocol groups (p = 0.0001). There was no difference in the incidence of hypokalemia, hypoglycemia, or cerebral edema. CONCLUSIONS: The protocol did not change time to normalization of ketoacidosis but did decrease the duration of insulin therapy, number of adjustments to insulin drip rate, and number of wasted IV fluid bags without increasing the incidence of adverse events.

scholarly journals Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis

Diabetes Care ◽  
2006 ◽  
Vol 29 (10) ◽  
pp. 2196-2199 ◽  
Author(s):  
A. Samann ◽  
I. Muhlhauser ◽  
R. Bender ◽  
W. Hunger-Dathe ◽  
C. Kloos ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
High Risk ◽  
Insulin Therapy ◽  
Diabetic Ketoacidosis ◽  
Intensive Insulin Therapy ◽  
Severe Hypoglycemia

Pulsatile intermittent intravenous insulin therapy for attenuation of retinopathy and nephropathy in type 1 diabetes mellitus

Metabolism ◽  
2010 ◽  
Vol 59 (10) ◽  
pp. 1429-1434 ◽  
Author(s):  
Larry A. Weinrauch ◽  
Jennifer Sun ◽  
Ray E. Gleason ◽  
Guenther H. Boden ◽  
R.H. Creech ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Type 1 Diabetes Mellitus ◽  
Intravenous Insulin

scholarly journals Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

2021 ◽  
Vol 9 (2) ◽  
pp. e002451
Author(s):  
Emma Ooi ◽  
Katrina Nash ◽  
Lakshmi Rengarajan ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Final Analysis ◽  
Care Hospital ◽  
Hospital Data ◽  
Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

Beta cell function after intensive subcutaneous insulin therapy or intravenous insulin infusion at onset of type 1 diabetes in children without ketoacidosis

2018 ◽  
Vol 19 (6) ◽  
pp. 1079-1085 ◽  
Author(s):  
Rebecka Enander ◽  
Peter Adolfsson ◽  
Torun Bergdahl ◽  
Gun Forsander ◽  
Johnny Ludvigsson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Beta Cell ◽  
Insulin Therapy ◽  
Beta Cell Function ◽  
Insulin Infusion ◽  
Cell Function ◽  
Subcutaneous Insulin ◽  
Intravenous Insulin

scholarly journals Effects of nicotinamide and intravenous insulin therapy in newly diagnosed type 1 diabetes

Diabetes Care ◽  
2000 ◽  
Vol 23 (3) ◽  
pp. 360-364 ◽  
Author(s):  
J. Vidal ◽  
M. Fernandez-Balsells ◽  
G. Sesmilo ◽  
E. Aguilera ◽  
R. Casamitjana ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Newly Diagnosed ◽  
Intravenous Insulin

scholarly journals Diabetic Ketoacidosis Revealing a Severe Hypertriglyceridemia and Acute Pancreatitis in Type 1 Diabetes Mellitus

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Fatima Zahra Zaher ◽  
Imane Boubagura ◽  
Sana Rafi ◽  
Ghizlane Elmghari ◽  
Nawal Elansari
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Biological Evolution ◽  
Intravenous Insulin ◽  
Severe Hypertriglyceridemia ◽  
Metabolic Complication ◽  
Patients With Diabetes

Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.

scholarly journals Type 1 diabetes and fasting during Ramzan

2016 ◽  
Vol 04 (01) ◽  
pp. 011-016 ◽  
Author(s):  
Rakesh Sahay ◽  
V. Nagesh
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Diabetic Ketoacidosis ◽  
Severe Hypoglycaemia ◽  
Diabetes Education ◽  
Therapeutic Options ◽  
Insulin Pumps ◽  
Ramadan Fasting ◽  
Recent Developments

AbstractFasting is one of the five pillars of Islam, and consequently, even the Muslims with diabetes prefer to fast fast during Ramadan, irrespective of the healthcare implications. However, this fast can be very difficult to manage in patients of Type 1 diabetes (T1DM), who are on insulin therapy. Risks of diabetic ketoacidosis, severe hypoglycaemia, hyperglycemia, dehydration and thrombotic episodes are increased. Lack of proper pre-fast assessment, management and diabetes education have been stumbling blocks in facilitating Ramadan fasting in type 1 diabetes patients. Recent developments like the use of insulin pumps and analogs and recognition of the importance of structured diabetes education and assessment to select the patients best suited for the rigors of fasting, have wrought a sea change in the usually negative approach of doctors towards Ramadan fasting in patients with T1DM. Sophisticated therapeutic options like smart insulins, can provide safer and more convenient options for management of Type 1 diabetes during Ramadan, a few years down the line. More studies are also needed to explore other options like GLP-1 agonists, alpha glycosides inhibitors and DDP-4 agonists, as adjuncts to insulin therapy.

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