Low-dose insulin in the treatment of diabetic ketoacidosis

Severe diabetic ketoacidosis remains a lethal condition. Many deaths occur during therapy and are avoidable. Treatment includes rehydration, administration of insulin and potassium, and clinical care. For many years very large doses of insulin were used. Recently, it has been suggested that such large doses are unnecessary and lead to undue hypokalemia, hypoglycemia, and osmotic disequilibria. Many studies are now available that show that low doses of insulin given as continuous intravenous infusions (4 to 10 units/hr) or as hourly intramuscular injections (20 units initially, then 5 units/hr) are as effective as large doses in treating severe ketoacidosis. The new regimens are simple to use, predictable, and safe. Potassium shifts are less than with large insulin doses and insulin resistance has been shown to be a relatively minor problem. The new regimens are particularly suitable for use in nonspecialist centers.