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Utility of initial bolus insulin in the treatment of diabetic ketoacidosis.
J Emerg Med. 2010 May; 38(4):422-7.JE

Abstract

Current guidelines for treatment of diabetic ketoacidosis (DKA) recommend administration of an intravenous bolus dose of insulin followed by a continuous infusion. This study was designed to investigate whether the initial bolus dose is of significant benefit to adult patients with DKA and if it is associated with increased complications. This was a non-concurrent, prospective observational cohort study of adult patients who presented with DKA in a 12-month period. Charts were divided into two groups depending on whether they received an initial bolus dose of insulin. Data on glucose levels, anion gap (AG), intravenous fluid administration (IVF), and length of stay (LOS) were collected. Primary outcome was hypoglycemia (need for administration of 50% dextrose). Of 157 charts, 78 received a bolus of insulin and were designated the treatment group, the remaining 79 formed the control group. Groups were similar at baseline and received equivalent IVF and insulin drips. There were no statistically significant differences in the incidence of hypoglycemia (6% vs. 1%, respectively, p = 0.12), rate of change of glucose (60 vs. 56 mg/dL/h, respectively, p = 0.54) or AG (1.9 vs. 1.9 mEq/L/h, respectively, p = 0.66), LOS in the Emergency Department (8 vs. 7 h, respectively, p = 0.37) or hospital (5.6 vs. 5.9 days, p = 0.81). Equivalence testing revealed no clinically relevant differences in IVF change, rate of change of glucose, or AG. Administration of an initial bolus dose of insulin was not associated with significant benefit to patients with DKA and demonstrated equivalent changes in clinically relevant endpoints when compared to patients not administered the bolus.

Authors+Show Affiliations

Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18514472

Citation

Goyal, Nikhil, et al. "Utility of Initial Bolus Insulin in the Treatment of Diabetic Ketoacidosis." The Journal of Emergency Medicine, vol. 38, no. 4, 2010, pp. 422-7.
Goyal N, Miller JB, Sankey SS, et al. Utility of initial bolus insulin in the treatment of diabetic ketoacidosis. J Emerg Med. 2010;38(4):422-7.
Goyal, N., Miller, J. B., Sankey, S. S., & Mossallam, U. (2010). Utility of initial bolus insulin in the treatment of diabetic ketoacidosis. The Journal of Emergency Medicine, 38(4), 422-7. https://doi.org/10.1016/j.jemermed.2007.11.033
Goyal N, et al. Utility of Initial Bolus Insulin in the Treatment of Diabetic Ketoacidosis. J Emerg Med. 2010;38(4):422-7. PubMed PMID: 18514472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of initial bolus insulin in the treatment of diabetic ketoacidosis. AU - Goyal,Nikhil, AU - Miller,Joseph B, AU - Sankey,Steadman S, AU - Mossallam,Usamah, Y1 - 2008/06/02/ PY - 2007/01/26/received PY - 2007/05/27/revised PY - 2007/11/02/accepted PY - 2008/6/3/pubmed PY - 2010/9/14/medline PY - 2008/6/3/entrez SP - 422 EP - 7 JF - The Journal of emergency medicine JO - J Emerg Med VL - 38 IS - 4 N2 - Current guidelines for treatment of diabetic ketoacidosis (DKA) recommend administration of an intravenous bolus dose of insulin followed by a continuous infusion. This study was designed to investigate whether the initial bolus dose is of significant benefit to adult patients with DKA and if it is associated with increased complications. This was a non-concurrent, prospective observational cohort study of adult patients who presented with DKA in a 12-month period. Charts were divided into two groups depending on whether they received an initial bolus dose of insulin. Data on glucose levels, anion gap (AG), intravenous fluid administration (IVF), and length of stay (LOS) were collected. Primary outcome was hypoglycemia (need for administration of 50% dextrose). Of 157 charts, 78 received a bolus of insulin and were designated the treatment group, the remaining 79 formed the control group. Groups were similar at baseline and received equivalent IVF and insulin drips. There were no statistically significant differences in the incidence of hypoglycemia (6% vs. 1%, respectively, p = 0.12), rate of change of glucose (60 vs. 56 mg/dL/h, respectively, p = 0.54) or AG (1.9 vs. 1.9 mEq/L/h, respectively, p = 0.66), LOS in the Emergency Department (8 vs. 7 h, respectively, p = 0.37) or hospital (5.6 vs. 5.9 days, p = 0.81). Equivalence testing revealed no clinically relevant differences in IVF change, rate of change of glucose, or AG. Administration of an initial bolus dose of insulin was not associated with significant benefit to patients with DKA and demonstrated equivalent changes in clinically relevant endpoints when compared to patients not administered the bolus. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/18514472/Utility_of_initial_bolus_insulin_in_the_treatment_of_diabetic_ketoacidosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(08)00042-5 DB - PRIME DP - Unbound Medicine ER -