The management of diabetic ketoacidosis by continuous infusion of low-dose insulin using the ordinary intravenous plastic bag and tubing

Although the hourly intramuscular insulin regimen has been used in the management of diabetic ketoacidosis (DKA) in Ethiopia for over 7 years, continuous intravenous (IV) insulin infusion has never been previously used. In Tikur Anbessa Hospital, Addis Abeba, in 198788, we used the ordinary IV plastic bag and tubings alone to concurrently infuse the low-dose insulin and hydration solution in the management of 15 episodes of DKA in 13 patients, 5 males and 8 females. Initial blood glucose was over 400 mg/dl and urine ketones 4+ in all, and the level of consciousness ranged from drowsy to coma. Initially, 5 to 10 units of crystalline zinc insulin (CZI) was given IV directly to all but 2 patients. Then CZI was added to the normal saline IV bag and the dose of insulin was adjusted according to fluid requirements while at the same time maintaining the insulin rate at 5 to 10 units/hour until the blood glucose dropped to 250 mg/dl or lower. At this point the IV fluid was changed to 5% dextrose and the insulin infusion was reduced to 2 to 4 units/hour. The mean insulin requirement until the dextrose infusion was initiated was 33.2 +/- 7.3 units, IV fluid requirement was 3.5 +/- 0.8 litres and mean duration of treatment 4.4 +/- 1.6 hours. There was one death which was not due to insulin resistance, while all other patients fully recovered. The study demonstrates that insulin infusion using the ordinary IV plastic bag and tubings is safe, simple, and convenient in the management of DKA and hence should be used whenever indicated and feasible.