Early Subcutaneous Insulin Glargine Plus Standard of Care for Treatment of Diabetic Ketoacidosis
Early Subcutaneous Insulin Glargine Plus Standard of Care for Treatment of Diabetic Ketoacidosis
The purpose of this study is to determine whether adult DKA patients who present to the
 emergency department treated with early subcutaneous long acting insulin versus standard care
 receive a shorter total duration of intravenous (IV) insulin infusion.
Specific Aims: To evaluate the impact of early administration of subcutaneous glargine versus
 standard care on time of insulin infusion in DKA patients and other secondary outcomes listed
 in this application.

 Methods: DKA patients enrolled in this study will receive the long acting glargine dose (0.3
 units/kg with a maximum dose of 30 units) within two hours after initiation the IV insulin
 infusion. Besides timing of the glargine dose, no other changes in standard patient care will
 occur in those patients enrolled in this study, the same labs will be collected and the
 insulin infusion will be titrated using the same hospital protocol algorithm.

 Patients enrolled in the prospective arm will be compared with the retrospective control
 group, which received standard insulin therapy (subcutaneous insulin glargine administered at
 least 2 to 3 hours prior to termination of the insulin infusion). There will be 18 patients
 in this group selected in reverse chronological order from our pre-specified date range of
 8/1/2014 to 7/31/2016.
Inclusion Criteria:

 -  Bicarbonate <18 mg/dL

 -  Anion gap >16

 -  Blood glucose >250 mg/dL

 -  Ketonemia or ketonuria

 Exclusion Criteria:

 -  Pregnant women

 -  Refused consent

 -  Patient left ED against medical advice