Diabetic ketoacidosis: Should current management include subcutaneous insulin injections?
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
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