More-Aggressive Insulin Therapy for Hyperglycemic Crisis Is Likely Not Beneficial

The ideal dosing of insulin early in the course of hyperglycemic crisis is unknown. Small studies have found no benefit from insulin boluses given prior to insulin drip therapy in patients with diabetic ketoacidosis (J Emerg Med 2010; 38:422 and Diabetes Care 2008; 31:2081).

Researchers compared outcomes between adult patients with hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar state) treated at a single institution in two time periods under different protocols. During the earlier period (2010–2012) an intensive insulin therapy protocol was used: bolus doses of insulin, target blood glucose of 100–200 mg/dL, and insulin drip rates starting at 0.1–0.2 units/kg/hour. During the later period a moderate-intensity insulin protocol wa…