Abstract
The effects of continuous i. v. infusion and repeated i. m. injection of small amounts of insulin were compared retrospectively in 18 patients with severe diabetes mellitus. Half of them, including 4 with ketoacidosis, 3 with ketosis and 2 with nonketotic hyperosmolar diabetic coma, were treated with continuous low dose insulin. The other 9 patients, including 5 with ketoacidosis and 4 with ketosis, were treated with repeated i. m. injections of small doses of insulin.
The results obtained were as follows.
1) The rate of blood glucose decline in the first 4 hr of continuous i. v. infusion and repeated i. m. injections was 104 mg/dl/hr and 110 mg/dl/hr, respectively.
2) The blood glucose levels fell below 250 mg/dl when 33 u of insulin was given in 6.9 hr by continuous i. v. infusion and when 55 U of insulin was given in 9 hr by repeated i. m. injections.
3) The amount of insulin used in the present study, i. e. 2-7.2 U/hr for continuous i. v. infusion and 6-20 U as initial dose in repeated i.m. injections, was sufficient to increase the plasma I. R. I. levels to 20-200 μU /ml within 1 hr.
4) Serum ketones became negative when 22 U of insulin was given in 11 hr by continuous i. v. infusion and when 33 U of insulin was given in 6 hr by repeated i. m. injections (p: n. s.).
5) Serum potassium fell with each therapeutic regimen within 1 hr following insulin administration. The mean rate of serum potassium decline was about the same in both therapeutic regimens.It was concluded that both the continuous i. v. infusion and repeated i. m. injections of small amounts of insulin were effective and safe in the management of severe diabetes mellitus. However, it should be pointed out that in continuous i. v. infusion, complete recovery from derangement of fat metabolism was to some extent sluggish in spite of prompt recovery of carbohydrate metabolism.
