Retrospective review on the use of subcutaneous insulin in the treatment of patients with mild to moderate diabetic ketoacidosis at Northwest Medical Center

Abstract

Specific aims: To measure the frequency of hypoglycemic and rebound hyperglycemic events, time to diabetic ketoacidosis (DKA) resolution, and hospital length of stay (LOS) in mild to moderate DKA patients with long-acting subcutaneous insulin. Methods: An emergency medicine pharmacist initiated long-acting subcutaneous insulin in patients with mild to moderate DKA at Northwest Medical Center (NMC). Patients were started on glargine insulin instead of intravenous insulin in the NMC emergency department from June 1 to December 31, 2024. Patient data such as sex, age, BMI, diabetes type, insulin dose, lab values, point of care glucose, date and time of admission/discharge, were collected using REDCap. Results: A total of 11 patients received subcutaneous insulin as treatment for mild DKA (male 55%; mean age 53.1; mean BMI 30.4). The median time to resolution was 12.5 hours. The frequency of hyperglycemic events and hypoglycemic events were 45.5% and 9.1%, respectively. The median LOS was 5.13 days with an outlier of 19.25 days. Conclusion: Subcutaneous insulin is an alternative intervention for mild DKA patients and has shown a median resolution time of less than one day. The next steps would be to evaluate the optimal dosing and treatment in patients using BMI and creatinine to reduce the incidence of hypoglycemia and rebound hyperglycemia after DKA resolution. There may be other factors affecting hypoglycemia and rebound hyperglycemia that we cannot control such as diet, activity, etc.