Nuances of insulin therapy in the treatment of the diabetic ketoacidosis

Background. The well-defined program of the insulin therapy is a guarantee of efficient treatment of a patient with the diabetic ketoacidosis. The approaches to the treatment varied depending on the gained experience, however, the experts’ opinions about the dose and methods of the insulin therapy are still ambiguous. The evaluation of the insulin therapy efficacy via continuous infusion by means of a syringe pump with the initial dose 0.1 unit/kg/h under the control of the glycemia without the usage of a bolus insulin dose IV and the determination of the necessary daily insulin dose on the first day of the diabetic ketoacidosis treatment. The purpose of the study — the evaluation of the insulin therapy efficacy for the diabetic ketoacidosis with syringe pump by means of the continuous infusion with the initial dose 0.1 unit/kg/h under the control of the glycemia as the principal component of the pathogenetic treatment and the determination of the necessary daily insulin dose on the first day of the diabetic ketoacidosis treatment in parallel with the rehydration start by means of physiological solution. Materials and methods. 55 patients with diabetic ketoacidosis aged from 9 to 65 years were examined. The average age of the patients was 31.58 ± 17.18 years. The specific weight of the female patients was 56 %, and male patients — 44 %. 80 % of patients had the type 1 diabetes mellitus. The determination of the glucose level was carried out in the capillary blood by means of the automatic glucose analyzer. For all the patients the glycemia was controlled in an hour after the injection of 0.1 unit/kg/h of insulin and then the dose was corrected in case of necessity with the control of the glucose level. For the treatment the fast-acting insulin was used and analogues of ultra fast-acting insulins, their total dose was calculated during the first day of treatment. Results. The glycemia level during the hospitalization fluctuated from 6.7 mmol/l to 62.2 mmol/l, at average it was 23.37 ± 10.16 mmol/l. 13 % of the patients had the glycemia of 13 mmol/l. 29 % of patients had the glycemia to 20 mmol/l, and 58 % of patients had the hyperglycemia of more than 20 mmol/l. 63,6 % of patients had the desirable dynamics of glycemia level in an hour after the injection of the calculated insulin dose, the glycemia decrease within an hour was 0.5–5.3 mmol/l, but it was noted the individual sensitivity to the injected insulin dose. The daily insulin dose fluctuated from 0.5 unit/kg daily to 5.83 unit/kg a day. The median of the daily insulin dose amidst the patients was 1.36 unit/kg and more often it was 0.92–1.88 unit/kg a day (25 %; 75 %). Conclusions. The insulin dose calculated as 0.1 unit/kg/h is efficient in most cases but due to the individual sensitivity to the injected insulin and the significant factor of the treatment efficiency is the glycemia control hourly for the opportune correction of the insulin dose