학술논문
A dose-defining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises
Document Type
Academic Journal
Source
Diabetes Management. July 2011, Vol. 1 Issue 4, p397, 16 p.
Subject
Language
English
ISSN
1758-1907
Abstract
Author(s): Radha Devi [sup.1] , Geetha Selvakumar [sup.1] , Lisa Clark [sup.1] , Carol Downer [sup.1] , Susan S Braithwaite [sup.[[dagger]]] [sup.2] Practice Points * Successful treatment of hyperglycemic crises [...]
SUMMARY According to current standards of care, insulin therapy of the hyperglycemic crises diabetic ketoacidosis and hyperglycemic hyperosmolar state may be ordered using a combination of weight-based and qualitative rules for the initiation and adjustment of the rate of intravenous insulin infusion. The early hours of treatment are often managed with a fixed-dose insulin regimen, such as 0.1-0.14 units/kg/h of insulin. Higher-dose insulin protocols, once used routinely, were replaced safely and effectively in the 1970s by low-dose regimens, possibly with a reduction in late hypoglycemia and hypokalemia. In a pediatric study comparing 43 cases of cerebral edema to 169 matched control subjects, the dose of insulin in the first 2 h was significantly associated with the risk of cerebral edema (p < 0.02 for trend over categories of insulin dose). Even with the use of low-dose insulin therapy, hypokalemia and hypoglycemia continue to occur. In one series, 13% (18 out of 144) of diabetic ketoacidosis patients had blood glucose
SUMMARY According to current standards of care, insulin therapy of the hyperglycemic crises diabetic ketoacidosis and hyperglycemic hyperosmolar state may be ordered using a combination of weight-based and qualitative rules for the initiation and adjustment of the rate of intravenous insulin infusion. The early hours of treatment are often managed with a fixed-dose insulin regimen, such as 0.1-0.14 units/kg/h of insulin. Higher-dose insulin protocols, once used routinely, were replaced safely and effectively in the 1970s by low-dose regimens, possibly with a reduction in late hypoglycemia and hypokalemia. In a pediatric study comparing 43 cases of cerebral edema to 169 matched control subjects, the dose of insulin in the first 2 h was significantly associated with the risk of cerebral edema (p < 0.02 for trend over categories of insulin dose). Even with the use of low-dose insulin therapy, hypokalemia and hypoglycemia continue to occur. In one series, 13% (18 out of 144) of diabetic ketoacidosis patients had blood glucose