Journal of Pharmacy Practice (JPP)Safety of an Initial Insulin Bolus in the Treatment of Diabetic Ketoacidosis

Investigating how an insulin bolus affects the management of diabetic ketoacidosis reveals startling new information.

In the diabetes field, experts widely use insulin as a core treatment for diabetic ketoacidosis (DKA). However, the debate over the best dosage and method of administration, specifically concerning the use of an initial insulin bolus, continues. This study evaluates the safety and effectiveness of this insulin bolus in DKA treatment.

Employing a retrospective chart review, researchers examined patient outcomes for DKA treatment with and without an insulin bolus. They included 59 patients in the bolus group, and 108 in the non-bolus group. The study primarily tracked whether the administration of insulin had to be interrupted, or if patients experienced hypoglycemia or hypokalemia within eight hours of starting insulin.

Comparing baseline characteristics, the groups showed no significant differences. Most patients exhibited mild DKA. Results revealed that adverse effects—particularly hypokalemia—occurred significantly more often in the bolus group (45.8% versus 25%, P = .003).

Additionally, while time to anion gap closure was shorter in the bolus group, this did not reach statistical significance (6:39 versus 9:00, P = .063). Similarly, non-significant differences emerged in time to discontinuation of insulin infusion and time to ICU and hospital discharge.

In conclusion, starting therapy with an insulin bolus led to significantly more early adverse effects. Crucially, this approach failed to provide a corresponding benefit in time to DKA resolution. This finding signals the need for further evaluation of the practice of initiating DKA treatment with an insulin bolus.