The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis

Magui Abdel Moneim Shalash; Ali Ahmed Abdel Rahim; Kamel Hemida Rohoma; Marwa Abdel Maaboud Elnabawy

doi:doi:10.11648/j.ajim.20160403.11

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The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis

Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy

Received: 13 April 2016 Accepted: 22 April 2016 Published: 11 May 2016

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Abstract

Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.

DOI	10.11648/j.ajim.20160403.11
Published in	American Journal of Internal Medicine (Volume 4, Issue 3, May 2016)
Page(s)	43-48
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Diabetes, Ketoacidosis, DKA, Insulin Pump, Continuous Subcutaneous Insulin Infusion

References

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APA Style

Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. (2016). The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. American Journal of Internal Medicine, 4(3), 43-48. https://doi.org/10.11648/j.ajim.20160403.11

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ACS Style

Magui Abdel Moneim Shalash; Ali Ahmed Abdel Rahim; Kamel Hemida Rohoma; Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am. J. Intern. Med. 2016, 4(3), 43-48. doi: 10.11648/j.ajim.20160403.11

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AMA Style

Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am J Intern Med. 2016;4(3):43-48. doi: 10.11648/j.ajim.20160403.11

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@article{10.11648/j.ajim.20160403.11,
  author = {Magui Abdel Moneim Shalash and Ali Ahmed Abdel Rahim and Kamel Hemida Rohoma and Marwa Abdel Maaboud Elnabawy},
  title = {The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis},
  journal = {American Journal of Internal Medicine},
  volume = {4},
  number = {3},
  pages = {43-48},
  doi = {10.11648/j.ajim.20160403.11},
  url = {https://doi.org/10.11648/j.ajim.20160403.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160403.11},
  abstract = {Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.},
 year = {2016}
}

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TY  - JOUR
T1  - The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis
AU  - Magui Abdel Moneim Shalash
AU  - Ali Ahmed Abdel Rahim
AU  - Kamel Hemida Rohoma
AU  - Marwa Abdel Maaboud Elnabawy
Y1  - 2016/05/11
PY  - 2016
N1  - https://doi.org/10.11648/j.ajim.20160403.11
DO  - 10.11648/j.ajim.20160403.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 43
EP  - 48
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20160403.11
AB  - Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.
VL  - 4
IS  - 3
ER  -

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Author Information

Magui Abdel Moneim Shalash

Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
Ali Ahmed Abdel Rahim

Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
Kamel Hemida Rohoma

Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
Marwa Abdel Maaboud Elnabawy

Internal Medicine Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

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APA Style

Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. (2016). The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. American Journal of Internal Medicine, 4(3), 43-48. https://doi.org/10.11648/j.ajim.20160403.11

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ACS Style

Magui Abdel Moneim Shalash; Ali Ahmed Abdel Rahim; Kamel Hemida Rohoma; Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am. J. Intern. Med. 2016, 4(3), 43-48. doi: 10.11648/j.ajim.20160403.11

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AMA Style

Magui Abdel Moneim Shalash, Ali Ahmed Abdel Rahim, Kamel Hemida Rohoma, Marwa Abdel Maaboud Elnabawy. The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis. Am J Intern Med. 2016;4(3):43-48. doi: 10.11648/j.ajim.20160403.11

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@article{10.11648/j.ajim.20160403.11,
  author = {Magui Abdel Moneim Shalash and Ali Ahmed Abdel Rahim and Kamel Hemida Rohoma and Marwa Abdel Maaboud Elnabawy},
  title = {The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis},
  journal = {American Journal of Internal Medicine},
  volume = {4},
  number = {3},
  pages = {43-48},
  doi = {10.11648/j.ajim.20160403.11},
  url = {https://doi.org/10.11648/j.ajim.20160403.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160403.11},
  abstract = {Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.},
 year = {2016}
}

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TY  - JOUR
T1  - The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis
AU  - Magui Abdel Moneim Shalash
AU  - Ali Ahmed Abdel Rahim
AU  - Kamel Hemida Rohoma
AU  - Marwa Abdel Maaboud Elnabawy
Y1  - 2016/05/11
PY  - 2016
N1  - https://doi.org/10.11648/j.ajim.20160403.11
DO  - 10.11648/j.ajim.20160403.11
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 43
EP  - 48
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20160403.11
AB  - Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.
VL  - 4
IS  - 3
ER  -

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