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• W2150871554 abstract "and objectives: The outcome of hyperglycaemic emergencies (HEs) depends on effective management for which insulin therapy is one of the principal cornerstones. The objective of this study was to compare the effectiveness of the intramuscular route of insulin therapy to the intravenous route in the treatment of these conditions. Subjects, Materials and Methods: Thirty-two patients presenting with HEs were treated with either intravenous insulin (IVIT) or intramuscular injection of insulin (IMIT). The patients consisted of 13(40.6%) individuals with diabetic ketoacidosis (DKA), 11(34.4%) with hyperglycaemic hyperosmolar state (HHS), and 8(25%) with normosmolar non-ketotic hyperglycaemic states (NNHS). Patients were randomly allocated to either of the insulin regimes. Plasma glucose was monitored hourly until it was lowered to 250mg/dl along with other indices. Results: The mean hourly rate of fall of plasma glucose level was significantly higher in the intravenous insulin therapy (IVIT) group than in the intramuscular insulin therapy (IMIT) group. There was a greater variation in the mean rates of fall of the plasma glucose level(PGL) in the IVIT group than in the IMIT group. The mean time to lower plasma glucose levels to 250mg/dl was shorter in the IVIT route than in the IMIT route, 3.6 (0.2) hours vs 4.2 (0.3) hours (p < 0.05). Patients with HHS took a longer time to achieve target PGL than the other types of HE. The total amount of insulin required to achieve a PGL of 250 mg/dl was much higher in the IMIT group than in the IVIT group (41.9(2.9) v 22.9(1.9) units, p<0.01). Irrespective of the insulin route, the total amount of insulin needed to achieve PGL of 250 mg/dl was in the decreasing order DKA, HHS, and NNHS. However, within insulin treatment groups, insulin requirements needed to reach the target plasma glucose concentration varied more widely across HE subtypes in the IVIT ((18.0(1.8) - 25.2(4.0) ) group than in the IMIT group (40.4(3.0) - 43.3(2.1) units). Conclusion: The use of IMIT in our environment is associated with a rate of fall of PGL that is more gradual and more predictable. Therefore in settings such as ours where most hyperglycaemic emergency patients are managed outside the tertiary health centers, IMIT protocols should be the preferred route in the management of HEs. (Int J Diabetes Metab 15:17-21, 2007)" @default.
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• W2150871554 date "2007-01-01" @default.
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• W2150871554 title "Plasma glucose response to insulin in hyperglycaemic crisis" @default.
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