The Effect of Coadministration of Long Acting Insulin in Acute Management of Diabetic Ketoacidosis

Presentation Number: SUN 626
Date of Presentation: April 2nd, 2017

Margaret Omatsone*1, Sabrina Arshed1 and Abdalla Yousif2
1Raritan Bay Medical Center, Perth Amboy, 2Raritan Bay Medical Center, Perth Amboy, NJ

Abstract

ABSTRACT

Background

Diabetic ketoacidosis(DKA) remains one of the most common acute complications of diabetes and may be a significant cause of mortality if not addressed in a timely fashion. IV insulin infusion is the standard of care to ensure rapid correction of acidosis as well as hyperglycemia. The use of long acting insulin has been reported in a few studies however the efficacy is yet to be proven(1).

Methods

A retrospective chart review of patients admitted for DKA in a community hospital between 2009 and 2013 was conducted comparing the clinical outcome of patients treated with iv insulin infusion (DKA1)(n=54) and those who received long acting insulin in addition to iv insulin infusion(DKA2)(n=52). In DKA2, subcutaneous long acting insulin was given to patients at the time of insulin infusion up to 4 hours from time of commencement of infusion. Inclusion criteria included blood glucose >250mg/dl, anion gap > 16 and pH of <7.3. Patients were excluded if bicarbonate level was >20 and pH >7.3 irrespective of blood glucose level or presence of ketonemia. The dose of insulin given at the time of admission was calculated based on weight and serial basal metabolic panel, venous pH and anion gap was monitored and recorded every 4 hours. The primary outcome of study was time to closure of anion gap and discontinuation of insulin drip. Secondary outcomes included length of hospital/ICU stay and incidence of adverse events, i.e. hypoglycemia.

Results

The mean blood glucose, venous pH and anion gap at initial presentation for DKA1 was 662, 7.139 and 27.8 respectively, for patients in DKA2, the mean was 659, 7.124 and 25.6 respectively. The estimated mean time to closure of anion gap (AG ≤12) was 16.37hrs in DKA1 group and 16.14hrs in DKA2 group. The estimated mean length of hospital stay was 4.15 days in the DKA2 group, and 5.47 days in the DKA1 group. Hypoglycemic episodes (blood glucose ≤60mg/dl) was noted in 3 patients in DKA1 group and 6 patients in DKA2 group. Our study shows there may be no difference in time to closure of anion gap in both groups, a shorter hospital stay but higher risk of hypoglycemia is seen with long acting insulin.

Conclusion

The use of long acting insulin in treatment of DKA is currently employed by some practitioners though studies are yet to prove beneficial effects. Long-acting insulin analog may have a role in enhancing the transition from continuous intravenous insulin infusion to subcutaneous therapy in patients with DKA (2). Although hypovolemia causes erratic absorption of insulin given subcutaneously, this mode of delivery is currently under study with shorter acting insulin and may be a useful adjunct to treatment of DKA in near future.

 

Nothing to Disclose: MO, SA, AY