Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis?
Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis?
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DOI：
10.2337/dc08-0509
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发表时间：
2008-11
期刊：
影响因子：
16.2
通讯作者：
Karas J
中科院分区：
文献类型：
--
作者：
Kitabchi AE;Murphy MB;Spencer J;Matteri R;Karas J
连续性-本研究的目的是评估胰岛素预激剂量与连续性胰岛素输注相比较，两次连续输注无预激剂量的有效性。研究设计和方法-该前瞻性随机方案使用了三种胰岛素治疗方法：1）负荷组，在12名糖尿病酮症酸中毒（DKA）患者中使用0.07单位/kg体重的常规胰岛素启动剂量，随后静脉注射0.07单位· kg-1 · h-1剂量;（2）非负荷组12例，常规胰岛素0.07单位· kg-1 · h-1，不加负荷剂量;（3）两次无负荷组，常规胰岛素0.14 · kg-1 · h-1，无负荷剂量。结果基于胰岛素治疗对DKA治疗和恢复期间生化和激素变化的影响。负荷组游离胰岛素值达到峰值两次空载组在5 min内达到峰值（460 μU/ml），60 min后达到平台（88 μU/ml）（200 μU/ml）。无负荷组达到峰值无负荷组中5例患者需要补充胰岛素剂量以将初始血糖水平降低10%;两次无负荷组和负荷组的患者则没有。除这些差异外，达到葡萄糖≤250 mg/dl、pH ≥7.3和HCO 3 − ≥15 mEq/l的时间在三组间无显著差异。结论-如果给予0.14单位· kg体重−1 · h−1（70 kg患者约10单位/h）的常规胰岛素剂量，DKA患者的低剂量胰岛素治疗中的预激剂量是不必要的。
OBJECTIVE—The purpose of this study was to assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous infusions without a priming dose. RESEARCH DESIGN AND METHODS—This prospective randomized protocol used three insulin therapy methods: 1) load group using a priming dose of 0.07 units of regular insulin per kg body weight followed by a dose of 0.07 unit · kg−1 · h−1 i.v. in 12 patients with diabetic ketoacidosis (DKA); 2) no load group using an infusion of regular insulin of 0.07 unit · kg body weight−1 · h−1 without a loading dose in 12 patients with DKA, and 3) twice no load group using an infusion of regular insulin of 0.14 · kg−1 · h−1 without a loading dose in 13 patients with DKA. Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA. RESULTS—The load group reached a peak in free insulin value (460 μU/ml) within 5 min and plateaued at 88 μU/ml in 60 min. The twice no load group reached a peak (200 μU/ml) at 45 min. The no load group reached a peak (60 μU/ml) in 60–120 min. Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not. Except for these differences, times to reach glucose ≤250 mg/dl, pH ≥7.3, and HCO3− ≥15 mEq/l did not differ significantly among the three groups. CONCLUSIONS—A priming dose in low-dose insulin therapy in patients with DKA is unnecessary if an adequate dose of regular insulin of 0.14 unit · kg body weight−1 · h−1 (about 10 units/h in a 70-kg patient) is given.
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影响因子：
16.2
作者：
BURGHEN, GA;ETTELDORF, JN;KITABCHI, AE
通讯作者：
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通讯作者：
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