Subcutaneous insulin is safe for treating diabetic cetoacidosis and avoiding complications

About 8,000 patients hospitalized for diabetic cetoacidosis participating in the study. One 30% have type 2 diabetes and 70% have type 1 diabetes.

In the EE.UU regularly insulin is taken intravenously. Photo: Shutterstock.

The results of la investigation apuntan que la INSULIN subcutaneous tissue to treat diabetic cetoacidosis (CAD) y prevent patients from entering an Intensive Care Unit. This process is reproducible injección de INSULIN intravenous y no reverse effects reported in adult patients selected for the study.

“We want to implement a subcutaneous protocol based on INSULIN to treat diabetic cetoacidosis in the correct patients it is safe and associated with significant changes in practiceincluding significant dissemination of non-UCI jurisdiction and reduction in the return bowl, as a result of hypoglycemic or mortality eventsinforms Medscape Medical News’s clients.

In the United States, regularly insulin is administered intravenously, and patients are exposed to UCI en function of the need for a stretch vigilance by some doctors. It is generated that the costs of treating CAD in the EE.UU. superen los $ 5 mil millones de dólares al año.

“UCI is an escalating resource that can exert a critical pressure during the stationary influence of the station how to demonstrate the COVID-19 pandemic. However, many specialists in EE.UU critical careers are able to identify the correct patients and you can implement the treatment and supervised supervision“, indicates.

“Our doctors have established acutumbrados to treat CAD with infusions of INSULIN for intravenous and in the UCI. Our consejo series que other organizations establish a multidisciplinary medical teamincluding emergency department, intensivists, endocrinologists, nurses and pharmacists, all in one a subcutaneous insulin protocol for patients with CAD“señalaron.

Based on the results of the study, the subcutaneous protocol has been adopted since April 2021 by the other 20 Kaiser Permanent hospitals in northern California. The team performs an additional analysis and uses continuous glucose monitoring to facilitate INSULIN subcutaneous to the sleeve of the CAD.

Involucrado Emergence Protocol, no UCI or higher room

As of 2016, the intervention protocol has been stabilized, released as a major caliber project at the Kaiser Permanent San Jose Medical Center, para adult patients not embarked with CAD without complications. The initial maneuver in the emergency department includes the administration of INSULIN glargina y lispro subcutaneous basadas en el peso, junto con bolos de Ringer lactato IV, dextrosa al 5% con infusion sol salucón salina normal u reposión de potasio.

The sleeve in general medical and surgical rooms inflates in the continuous expansion of volume with liquid of Ringer lactate and lees based on the weight every 4 hours as the glucose level in the sea igual or lower than 250 mg / dL. The dexterity and saline solution are continual as long as the patients are treated with the dosage of INSULIN según las mediciones en sangre. Electrolytes are controlled and repaired as soon as possible.

For those who have proven diabetes mellitus, send an electronic health record message to the posterior segregation alta. Los patients with type 2 diabetes are referred to the manual of the conditioning program.

Results of the subcutaneous protocol

The results of the protocol intervention period, from January 1, 2017 to December 31, 2019, are compared with the pre-implementation period in the Kaiser San Jose institution from January 1, 2010 to December 31, 2015.

It produces a total of 7,989 hospitalizations by CAD out of 5,046 patients, including 4,739 hospitalizations (59.3%) that ensure ante implementation of the protocol and 3,250 (40.7%) that anticipate deprivation of implementation. Los patients only have a median age of 42.3 years y el 51.8% eran mujeres.

Before the implementation, the INSULIN subcutaneous fue la primera INSULIN administered 40 hospitalizations in the area of ​​intervention (13.4%) against 98 (80.3%) with the new protocol. For the contrary, do not produce any significant change in the attraction sites stand before and after implementation (14.7% open to 12.8%).

Proportions with hypoglycemia (serial glucose levels <70 mg / dl at any given time) are reduced by 12% to 9% by weight implementation of the protocol at the intervention site and from 15% to 9% in the standing attraction sites.

Due to the adjustments, the reductions made in the UCI as well as in the reversal of the 30 days in the intervention site in comparison with the sites standing are significant, of 57% and 50%, respectively. The difference in the distance of the distance, up to 3%, does not matter.