Skip to main content
NCBI home page
British Medical Journal logoLink to British Medical Journal
. 1974 Jun 29;2(5921):691–694. doi: 10.1136/bmj.2.5921.691

Treatment of Severe Diabetes Mellitus by Insulin Infusion

Warren Kidson, John Casey, Edward Kraegen, Leslie Lazarus
PMCID: PMC1611113  PMID: 4855256

Abstract

A new and simple form of insulin therapy for diabetic hyperglycaemia and ketoacidosis has been developed using a continuous intravenous infusion of insulin at a rate of 2·4 U/hr to maintain serum insulin concentration at physiological levels. This rate raises the mean serum insulin to 83 μU/ml and has a therapeutic effect which is not augmented by higher infusion rates. The response to such low doses of insulin indicates a need for a reappraisal of currently held theories about insulin resistance in diabetic ketoacidosis. In 11 diabetic patients with a mean plasma glucose of 514 mg/100 ml this therapy produced continuous falls in plasma glucose at a mean rate of 75 mg/100 ml/hr, and 10 out of 11 patients recovered within eight hours. This form of therapy is simple to institute, not complicated by hypoglycaemia, and avoids the confusion and empiricism of previously described forms of therapy.

Full text

PDF
691

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alberti K. G., Hockaday T. D., Turner R. C. Small doses of intramuscular insulin in the treatment of diabetic "coma". Lancet. 1973 Sep 8;2(7828):515–522. doi: 10.1016/s0140-6736(73)92346-5. [DOI] [PubMed] [Google Scholar]
  2. Clements R. S., Jr, Prockop L. D., Winegrad A. I. Acute cerebral oedema during treatment of hyperglycaemia. An experimentsl model. Lancet. 1968 Aug 17;2(7564):384–386. doi: 10.1016/s0140-6736(68)90597-7. [DOI] [PubMed] [Google Scholar]
  3. FERREBEE J. W., JOHNSON B. B., MITHOEFER J. C., GARDELLA J. W. Insulin and adrenocorticotropin labelled with radio-iodine. Endocrinology. 1951 Mar;48(3):277–283. doi: 10.1210/endo-48-3-277. [DOI] [PubMed] [Google Scholar]
  4. GALLOWAY J. A., SHUMAN C. R. Diabetes and surgery. A study of 667 cases. Am J Med. 1963 Feb;34:177–191. doi: 10.1016/0002-9343(63)90052-4. [DOI] [PubMed] [Google Scholar]
  5. Genuth S. M. Constant intravenous insulin infusion in diabetic ketoacidosis. JAMA. 1973 Mar 19;223(12):1348–1351. [PubMed] [Google Scholar]
  6. Ginsberg S., Block M. B., Mako M. E., Rubenstein A. H. Serum insulin levels following administration of exogenous insulin. J Clin Endocrinol Metab. 1973 Jun;36(6):1175–1179. doi: 10.1210/jcem-36-6-1175. [DOI] [PubMed] [Google Scholar]
  7. HALES C. N., RANDLE P. J. Immunoassay of insulin with insulin antibody preciptate. Lancet. 1963 Jan 26;1(7274):200–200. doi: 10.1016/s0140-6736(63)91215-7. [DOI] [PubMed] [Google Scholar]
  8. Hepp D., Poffenbarger P. L., Ensinck J. W., Williams R. H. Effects of nonsuppressible insulin-like activity and insulin on glucose oxidation and lipolysis in the isolated adipose cell. Metabolism. 1967 May;16(5):393–401. doi: 10.1016/0026-0495(67)90129-1. [DOI] [PubMed] [Google Scholar]
  9. Lavis V. R., Williams R. H. Lipolytic effects of high concentrations of insulin on isolated fat cells. Enhancement of the response to lipolytic hormones. Diabetes. 1973 Aug;22(8):629–636. doi: 10.2337/diab.22.8.629. [DOI] [PubMed] [Google Scholar]
  10. Stern M. P., Farquhar J. W., Silvers A., Reaven G. M. Insulin delivery rate into plasma in normal and diabetic subjects. J Clin Invest. 1968 Sep;47(9):1947–1957. doi: 10.1172/JCI105884. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Sönksen P. H., Srivastava M. C., Tompkins C. V., Nabarro J. D. Growth-hormone and cortisol responses to insulin infusion in patients with diabetes mellitus. Lancet. 1972 Jul 22;2(7769):155–159. doi: 10.1016/s0140-6736(72)91328-1. [DOI] [PubMed] [Google Scholar]
  12. Turner R. C., Grayburn J. A., Newman G. B., Nabarro J. D. Measurement of the insulin delivery rate in man. J Clin Endocrinol Metab. 1971 Aug;33(2):279–286. doi: 10.1210/jcem-33-2-279. [DOI] [PubMed] [Google Scholar]
  13. WALKER B. G., PHEAR D. N., MARTIN F. I., BAIRD C. W. INHIBITION OF INSULIN BY ACIDOSIS. Lancet. 1963 Nov 9;2(7315):964–965. doi: 10.1016/s0140-6736(63)90670-6. [DOI] [PubMed] [Google Scholar]
  14. WILLIAMSON J. R., KREBS H. A. Acetoacetate as fuel of respiration in the perfused rat heart. Biochem J. 1961 Sep;80:540–547. doi: 10.1042/bj0800540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Weisenfeld S., Podolsky S., Goldsmith L., Ziff L. Adsorption of insulin to infusion bottles and tubing. Diabetes. 1968 Dec;17(12):766–771. doi: 10.2337/diab.17.12.766. [DOI] [PubMed] [Google Scholar]
  16. Winegrad A. I., Clements R. S., Jr Diabetic ketoacidosis. Med Clin North Am. 1971 Jul;55(4):899–911. doi: 10.1016/s0025-7125(16)32484-1. [DOI] [PubMed] [Google Scholar]
  17. YALOW R. S., BERSON S. A. Immunoassay of endogenous plasma insulin in man. J Clin Invest. 1960 Jul;39:1157–1175. doi: 10.1172/JCI104130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. YALOW R. S., BERSON S. A. Immunologic aspects of insulin. Am J Med. 1961 Dec;31:882–891. doi: 10.1016/0002-9343(61)90030-4. [DOI] [PubMed] [Google Scholar]
  19. ZIERLER K. L., RABINOWITZ D. EFFECT OF VERY SMALL CONCENTRATIONS OF INSULIN ON FOREARM METABOLISM. PERSISTENCE OF ITS ACTION ON POTASSIUM AND FREE FATTY ACIDS WITHOUT ITS EFFECT ON GLUCOSE. J Clin Invest. 1964 May;43:950–962. doi: 10.1172/JCI104981. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES