Background: As the prevalence of diabetes increases in both industrialized and developing countries, the incidence of diabetic ketoacidosis (DKA) is also increasing. DKA is a potentially fatal condition, but is highly treatable and has an excellent prognosis when timely intervention is available. Mainstay treatment for DKA includes intravenous fluids and low-dose fast-acting insulin regardless of the route of administration (IV infusion or intermittent IM/SC); to date there is no definitive study establishing the superiority of either IV infusion or intermittent SC administration of insulin for the treatment of DKA.

Methodology: This was a randomized controlled open-label clinical trial study that was carried out at the MNH Emergency Department in patients diagnosed with DKA. 30 patients were randomly assigned to one of two groups. One group had 14 patients who were treated with IV continuous regular soluble insulin and other group had 16 patients who were treated with SC intermittent regular soluble insulin. A difference of ≥ 2 hours between two groups of treatment was considered as clinically significant.

Results: The demographic, clinical and biochemical parameters on presentation to the EMD similar and not statistically significantly between the two groups of treatment. There was no statistical difference between patients treated with IV continuous infusion and SC intermittent of regular soluble insulin in mean time to resolution of DKA. There were no statistical significant differences in either of the treatment group (IV or SC) for both precipitating factors (infection and poor compliance/out of medication) based on time to resolution of DKA, total amount of insulin used till resolution of DKA and rate of glucose drop per hour.

Conclusion and Recommendation: This study suggests that even severe DKA can be managed using SC intermittent low dose regular soluble insulin therapy and can be managed effectively even where infusion pumps and rapid acting insulin analogues are not available.