scholarly journals Diabetic Ketoacidosis Updates: Titratable Insulin Infusions and Long-Acting Insulin Early

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Justin Kinney ◽  
Oshin Baroi ◽  
Mania Gharibian
Keyword(s):  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Hospital Length ◽  
Adult Patients ◽  
Early Administration ◽  
Hospital Survival ◽  
Acting Insulin ◽  
Long Acting ◽  
Infusion Duration ◽  
Order Set

Background. To compare a titratable insulin infusion order set (vs. nontitratable) and early administration of long-acting insulin in adult patients with diabetic ketoacidosis (DKA). Methods. Single health system, retrospective study of adult patients admitted to the intensive care unit (ICU) for DKA. The primary outcomes were insulin infusion duration and ICU/hospital length of stays (LoS). Secondary outcomes included ICU/hospital survival, hypoglycemia, and hypokalemia. Results. 151 patients were included in the titratable versus nontitratable insulin infusion comparison. Patients treated with the titratable insulin had shorter hospitalization (6.4 vs. 10.4 days, p = 0.03 ) and reduced the number hypoglycemic events by over half (20.6% vs. 46.0%, p < 0.01 ). 110 patients were identified to compare overlapping a long-acting insulin for more than 4 h with the insulin infusion versus the standard 1-2 h overlap. Patients who received the insulin early spent over 18 h longer on the infusion ( p < 0.01 ). Conclusions. A titratable insulin infusion added to the institutional DKA order set was associated with fewer days in the hospital and a significant reduction in hypoglycemic events. Furthermore, overlapping the long-acting insulin earlier with the insulin infusion early showed no benefit and could potentially be worse than the standard overlap.

EP.TU.200Improving variable rate insulin infusion compliance in general surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jayan George ◽  
Samuel Jackson ◽  
Andrew Orsi ◽  
Rohan Ardley
Keyword(s):  
Insulin Infusion ◽  
Further Education ◽  
Junior Doctors ◽  
Variable Rate ◽  
Oral Medications ◽  
Acting Insulin ◽  
Open Questions ◽  
Audit Data ◽  
Improve Compliance ◽  
Long Acting

Abstract Aims 1. Audit the current variable rate insulin infusion (VRII) practice per local guidelines. 2. Understand barriers to good VRII practice to create an intervention. 3. Re-Audit the VRII practice following intervention. Methods Junior doctors were surveyed using Likert scales (1 to 5: not at all confident to very confident) as well as closed and open questions. Chain action reaction (CAR) theory was used. Six domains were identified against a local proforma. Initial audit and questionnaire were collected from November 2019 to January 2020 and analysed using Microsoft Excel. Intervention consisted of a condensed one-page algorithm with group teaching. Re-audit data was collected between June 2020 to August 2020 for comparison. Results Questionnaire – 53.6% (15/28) of juniors responded. Challenges included conversion oral hypoglycaemics and complexity of the guidance. Group teaching and a condensed portable format were the most popular modalities for delivery of further education. Initial Audit – 12 VRII charts were audited. 33.3% (4/12) were completed correctly. Areas of significant need for improvement were as follows: ensuring long-acting insulin is prescribed, transferring from a VRII back to oral medications and appropriate fluid prescribing. Re-Audit – 18 charts were audited following intervention. Of these, 66.7% (12/18) were completed correctly. There was a significant improvement in appropriate fluid prescribing and long-acting insulin prescriptions. Conclusions Understanding the factors involved throughout the chain of how VRIIs are prescribed has helped to implement a positive intervention in our department. The improvement has been significant (100% better) however there is still further work required to improve compliance.

scholarly journals Sepsis in Latent Autoimmune Diabetes in Adults with Diabetic Ketoacidosis: A Case Report

2019 ◽  
Vol 7 (20) ◽  
pp. 3501-3504
Author(s):  
Afdol Rahmadi ◽  
Eva Decroli ◽  
Alexander Kam
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Autoimmune Diabetes ◽  
Β Cells ◽  
Latent Autoimmune Diabetes ◽  
Acting Insulin ◽  
Short Acting Insulin ◽  
Lower Lung ◽  
Long Acting

BACKGROUND: This case report intends to highlight the challenge in diagnosing type 1 diabetes on an adult patient. Latent Autoimmune Diabetes in Adult (LADA) types I diabetes Mellitus, which found in adulthood and characterised by progressive damage to pancreatic β cells that happened slowly. Incidence of LADA is around 2-12% of the total diabetes population. Sepsis in LADA patients will trigger diabetic ketoacidosis (DKA). CASE REPORT: We report a case of a 33-year-old woman patient presents with decreased consciousness accompanied by rapid and deep breathlessness for 1 day. Before, the patient complains of fever and cough. Physical examination found soporous, blood pressure 120/80 mmHg, pulse 110 x/minute, temperature 38.8°C, breathing 32 x/minute Kussmaul. Bronchovesicular breath crackles in both lower lung fields. leukocytes were 22,100/mm3, random blood glucose 638 mg/dL, urine ketone +++, HbA1C 17.2%, HOMA IR less than 2 units. C-peptide 0.3 ng/mL and GADAs 16.9 U/mL. Chest Xray indicated bronchopneumonia. Patients were diagnosed with diabetic ketoacidosis, LADA, and sepsis caused by bronchopneumonia. Patient treated with DKA management and sepsis. On the second day, the treatment of DKA was resolved and continued with the administration of short-acting insulin and regular long-acting. CONCLUSION: Sepsis in LADA with DKA requires fast and appropriate management. Further search is needed to diagnose LADA.

Sign in / Sign up

Export Citation Format

Share Document