The effect of small-dose intravenous insulin boluses was compared with that of conventional large-dose insulin therapy by the intravenous and subcutaneous routes in 9 patients with severe diabetic ketoacidosis.
In the treatment with small-dose intravenous insulin boluses, 4 patients presenting semicoma received hourly intravenous injections of 8 units of regular insulin (RI) and one patient presenting coma received an initial intravenous injection of 20 units of RI with subsequent hourly injections of 10 units of RI.
The pretreatment blood glucose level was 892±131 mg/dl (M±SE) in the small-dose group, and 692±121 mg/dl in the large-dose group. The blood glucose dropped to levels of less than 250 mg/dl in 8±2 hr and 6±2 hr, respectively, and the amount of insulin necessary to lower blood glucose to these levels was 72±21 u and 97±19 u, respectively. The rate of fall in blood glucose per hour until then was 91±12 mg/dl in the former and 98±27 mg/dl in the latter. The percent decrease from the initial blood glucose level was 59±8 % and 61±8 % in 6 hr, respectively. These data were not significantly different between the two groups. The IRI concentrations measured at just before the insulin injections during the treatment with small-dose intravenous insulin boluses (n = 3) ranged from 18 to 43 μu/ml. No hypoglycemia or hypokalemia was observed in either of the groups.
These results suggest that small-dose intravenous insulin boluses are simple and as effective as conventional large-dose insulin therapy in the treatment of diabetic coma. Furthermore, it has been confirmed that the amelioration of hyperglycemia seen in diabetic coma can be attained by the same amount of insulin in both groups.