EFFICACY OF LOW-DOSE VERSUS CONVENTIONAL THERAPY OF INSULIN FOR TREATMENT OF DIABETIC KETOACIDOSIS

The effect of low-dose i.m. insulin therapy was compared with that of high-dose insulin therapy by i.v. and s.c. routes in 48 patients with diabetic ketoacidosis. A simplified protocol was devised to compare efficacy of the 2 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 [units] 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 2 groups were comparable. No treatment complications were noted in the low-dose group. Low-dose i.m. insulin therapy is simple and probably as effective as high-dose therapy in the treatment of diabetic ketoacidosis without the risk of hypoglycemia and with a diminished incidence of hypokalemia. The favorable response to low-dose insulin therapy suggests the absence of insulin resistance in diabetic ketoacidosis.