Subcutaneous Insulin Lispro Safe and Effective for Diabetic Ketoacidosis

Treatment with subcutaneous insulin lispro in a non – ICU setting is a safe and effective treatment for uncomplicated diabetic ketoacidosis. Unlike regular insulin, which is continuously pumped into the veins when treating DKA, lispro is given intermittently with shots. As a result, regular insulin therapy usually requires treatment in the intensive care unit, whereas lispro does not. For this reason, lispro has the potential to greatly reduce hospital costs.

Dr. Guillermo E. Umpierrez, from Emory University in Atlanta, assessed the outcomes of 40 diabetic ketoacidosis patients who were randomized to receive subcutaneous insulin lispro or intravenous regular insulin.
All of the subjects in the regular insulin group were treated in the ICU, whereas half the insulin lispro subjects were treated on a medicine ward and half were treated in a step-down unit.

The patients’ biochemical parameters on admission were similar in each group, the researchers point out. Moreover, the time needed to correct the biochemical abnormalities was comparable in each group–about 7 hours were required to correct the hyperglycemia and around 10.5 hours were needed to resolve the ketoacidosis.

The groups were also similar in terms of length of hospital stay, hypoglycemia rate, and the amount of insulin used before ketoacidosis resolution. No deaths occurred in either group.
The average hospitalization charge for diabetic ketoacidosis treated in the ICU setting was $14,429, almost 40% higher than the charge for treatment with lispro in non-ICU settings, at $8801 (p < 0.01).

The findings "raise interesting questions regarding the most cost-effective and labor-saving methods for treating a common disease in the hospital setting," Dr. Romana M. Haas and Dr. Andrew R. Hoffman, from Stanford University in California, note in a related editorial.

"Since many cases of uncomplicated DKA are now being treated in emergency departments or overnight treatment units, it will be important to perform similar analyses in these settings."
Am J Med 2004;117:291-296,357-358.
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