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The Efficacy of Low-Dose Versus Conventional Therapy of Insulin for Treatment of Diabetic Ketoacidosis

ABBAS E. KITABCHI, Ph.D., M.D.; VENTACHALAM AYYAGARI, M.D.; SONIA M. O. GUERRA, M.D., MEDICAL HOUSE STAFF
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Grant support: in part by National Institutes of Health, grant AM 15509, training grant AM 05497, General Clinical Research Centers grant RR 00211, Memphis Regional Medical Program grant 5G03-RM-00051-07, and a research grant from Eli Lilly Company, Indianapolis, Indiana.

Presented in part at the Central Society for Clinical Research 47th Annual Meeting, 31 October through 2 November 1974, Chicago, Illinois; and American Diabetes Association 35th Annual Meeting, 15 through 17 June, 1975, New York, New York.

▸Requests for reprints should be addressed to Abbas E. Kitabchi, Ph.D., M.D.; Division of Endocrinology and Metabolism, Department of Medicine, University of Tennessee Center for the Health Sciences, 951 Court Avenue; Memphis, TN 38163.


Memphis, Tennessee


Ann Intern Med. 1976;84(6):633-638. doi:10.7326/0003-4819-84-6-633
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The effect of low-dose intramuscular insulin therapy was compared with that of high-dose insulin therapy by intravenous and subcutaneous routes in 48 patients with diabetic ketoacidosis. A simplified protocol was devised to compare efficacy of the two methods of therapy in a randomized manner. Plasma glucose dropped to less than 250 mg/dl in the low-dose group in 6.7 ± 0.8 h and in the high-dose group in 4.5 ± 0.8 h (P = not significant). The amount of insulin necessary to lower plasma glucose to 250 mg/dl was 263 ± 45 U in the high-dose group and 46 ± 5 U in the low-dose group. Twenty five percent in the high-dose group and none in the low-dose group developed hypoglycemia. Other biochemical and clinical variables in the two groups were comparable. No treatment complications were noted in the low-dose group. Our studies suggest that low-dose intramuscular insulin therapy is simple and as effective as high-dose therapy in the treatment of diabetic ketoacidosis without the risk of hypoglycemia and with a diminished incidence of hypokalemia. Furthermore, the favorable response of these patients to low-dose insulin therapy suggests the absence of insulin resistance in diabetic ketoacidosis.

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Profound hypokalemia associated with severe diabetic ketoacidosis. Pediatr Diabetes Published online Nov 27, 2014.;
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