Fixed‐rate insulin for adult diabetic ketoacidosis is associated with more frequent hypoglycaemia than rate‐reduction method: a retrospective cohort study

Objective To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed‐rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia. Methods We retrospectively reviewed charts from adul...

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Bibliographic Details
Published in:The International journal of pharmacy practice 2019-08, Vol.27 (4), p.380-385
Main Authors: Lorenson, Jessica L., Cusumano, Michael C., Stewart, Anna M., Buhnerkempe, Michael G., Sanghavi, Devang
Format: Article
Language:English
Subjects:
Adult
Blood Glucose - analysis
Cohort analysis
Diabetes
Diabetic ketoacidosis
Diabetic Ketoacidosis - blood
Diabetic Ketoacidosis - drug therapy
Dose-Response Relationship, Drug
Female
Glucose
Humans
hypoglycaemia
Hypoglycemia
Hypoglycemia - blood
Hypoglycemia - chemically induced
Hypoglycemia - epidemiology
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - adverse effects
Incidence
Insulin
Insulin - administration & dosage
Insulin - adverse effects
intensive care unit
Length of Stay
Male
Middle Aged
protocol
Retrospective Studies
Young Adult
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Summary:Objective To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed‐rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia. Methods We retrospectively reviewed charts from adult patients managed with a DKA order set before and after order set revision. In cohort 1 (n = 77), insulin rate was 0.1 unit/kg/h with no adjustments and dextrose was infused at 12.5 g/h after glucose reached 250 mg/dl. In cohort 2 (n = 78), insulin was reduced to 0.05 unit/kg/h concurrent with dextrose initiation at 12.5 g/h after glucose reached 200 mg/dl. The primary outcome was hypoglycaemia (glucose 
ISSN:0961-7671
2042-7174
DOI:10.1111/ijpp.12525