title: Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs.
abstract: OBJECTIVE
  To compare the efficacy and safety of rapid acting insulin analog lispro given subcutaneously with that of standard low-dose intravenous regular insulin infusion protocolin patients with mild to moderate diabetic ketoacidosis.
  
  
  METHODS
  In this prospective, randomized and open trial, 50 consecutive patients of mild to moderate diabetic ketoacidosis were randomly assigned to two groups. The patients in group 1 were treated with intravenous regular insulin infusion and admitted in intensive care unit. The patients in group 2 were treated with subcutaneous insulin lispro 2 hourly and managed in the emergency medical ward. Response to therapy was assessed by duration of treatment and amount of insulin administered until resolution of hyperglycemia and ketoacidosis, total length of hospital stay, and number of hypoglycemic events in the two study groups.
  
  
  RESULTS
  The baseline clinical and biochemical parameters were similar between the two groups. There were no differences in the mean duration of treatment and amount of insulin required for correction of hyperglycemia and ketoacidosis. There was no mortality and no difference in the length of hospital stay between the two groups. The length of stay and amount of insulin required for correction of hyperglycemia was greater in patients who had infection as the precipitating cause than those with poor compliance. The hypoglycemic events were higher in the regular insulin group (2 vs1) than in the lispro group.
  
  
  CONCLUSIONS
  Patients with uncomplicated diabetic ketoacidosis can be managed in the medical wards with appropriate supervision and careful monitoring. Rapid acting insulin analog lispro is a safe and effective alternative to intravenous regular insulin for this subset of patients.
authors.affiliation: Department of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India.
authors.forename: R
authors.initials: R
authors.lastname: Karoli
authors.forename: J
authors.initials: J
authors.lastname: Fatima
authors.forename: T
authors.initials: T
authors.lastname: Salman
authors.forename: S
authors.initials: S
authors.lastname: Sandhu
authors.forename: R
authors.initials: R
authors.lastname: Shankar