Diabetic ketoacidosis: Should current management include subcutaneous insulin injections?

Abstract

Diabetic ketoacidosis is a well-known acute complication in patients with both type 1 and type 2 diabetes mellitus. Although mortality has decreased considerably, it remains an important cause for admission to intensive care units. Medical management includes intravenous fluid therapy, insulin, correction of electrolyte abnormalities, and addressing the precipitating factor which in most cases is infection or non-compliance with insulin therapy. Usually patients with diabetic ketoacidosis are admitted to the intensive care unit for continuous infusion of insulin; however, the development of rapid acting insulin analogues has made it possible to treat mild to moderate diabetic ketoacidosis with subcutaneous insulin. Although studies using subcutaneous insulin include only a small number of patients, this approach seems as effective as intravenous insulin infusions in patients with mild to moderate diabetic ketoacidosis. Diabetic education and close follow-up for patients admitted for diabetic ketoacidosis remain essential to avoid recurrence and readmissions. Keywords: Diabetic ketoacidosis, acute complication in diabetes, rapid acting insulin analogues, subcutaneous insulin in diabetic ketoacidosis