Evaluation of Insulin Infusion Rates for the Treatment of Diabetic Ketoacidosis in the Emergency Department

Introduction: There is minimal literature to support the appropriate dosing for the initiation of IV regular insulin therapy in DKA patients. A 0.1 unit/kg bolus followed by 0.1 units/kg/hour or 0.14 units/kg/hour is commonly utilized and recommended in guidelines. Objective: We sought to assess clinical and safety outcomes associated with various insulin infusion starting doses in patients diagnosed with DKA in the emergency department in an effort to help guide prescribing. Methods: A retrospective cohort study was conducted within an academic emergency department and included patients who received continuous infusion regular insulin with an ICD-10 code for DKA between January 2016 and January 2019. A predictive regression model was applied to test if predefined lab values influenced the starting insulin infusion rates. Clinical and safety outcomes were evaluated by starting insulin infusion rate. Data was analyzed based on starting insulin infusion rates. Results: 347 patients met inclusion criteria with 92 (26.5%) patients receiving Conclusion: Glucose levels significantly influenced the insulin starting infusion rate, with no identified differences in adverse effects or clinical outcomes.

Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis:A retrospective single-center study

BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has increased yearly,but updated population-based estimates on the incidence of HTG-AP are lacking.Reducing serum triglyceride(TG)levels quickly is crucial in the early treatment of HTG-AP.Decreased serum TG levels are treated by non-invasive methods,which include anti-lipidemic agents,heparin,low-molecular weight heparin,and insulin,and invasive methods,such as blood purification including hemoperfusion(HP),plasmapheresis,and continuous renal replacement therapy.However,authoritative guidelines have not been established.Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIM To evaluate the effect between patients treated with intravenous insulin(INS)and HP to guide clinical treatment.METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021.The inpatient medical and radiologic records were reviewed to determine clinical features,severity,complications,mortality,recurrence rate,and treatment.Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP.Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTS A total of 371 patients met the HTG-AP criteria.The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years(8.4%in April 2012-March 2013 and 22.3%in April 2020-March 2021).The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years.The amylase level was elevated in 80.1%of patients but was only three times the normal value in 46.9%of patients.The frequency of severe acute pancreatitis(26.9%),organ failure(31.5%),rate of recurrence(32.9%),and mortality(3.0%)of HTG-AP was high.Improved Marshall score,modified computed tomography severity index score,baseline TG,baseline amylase,C-reactive protein(CRP),albumin,aspartate aminotransferase,low-density lipoprotein cholesterol,urea nitrogen,creatinine,calcium,hemoglobin,free triiodothyronine,admission to intensive care unit,and mortality were significantly different between patients with different grades of severity(P<0.050).Multivariate logistic regression analysis confirmed that high CRP[P=0.005,odds ratio(OR)=1.011,95%CI:1.003-1.019],low calcium(P=0.003,OR=0.016,95%CI:0.001-0.239),and low albumin(P=0.023,OR=0.821,95%CI:0.693-0.973)were risk factors of severe HTG-AP.After propensity score matching adjusted by sex,age,severity of HTG-AP,and baseline TG,the serum TG significantly decreased in patients treated with INS(P<0.000)and HP(P<0.000)within 48 h.However,the clearance rate of TG(57.24±33.70%vs 56.38±33.61%,P=0.927)and length of stay(13.04±7.92 d vs 12.35±6.40 d,P=0.730)did not differ between the two groups.CONCLUSION The incidence of HTG-AP exhibited a significant increase,remarkable severity,and recurrent trend.Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Use of First-phase Insulin Secretion in Early Diagnosis of Thyroid Diabetes and Type 2 Diabetes Mellitus

Background：A relationship between hyperthyroidism and insulin secretion in type 2 diabetes mellitus （T2DM） has been reported.Therefore,this study explored the use of first-phase insulin secretion in the differential diagnosis of thyroid diabetes （TDM） and T2DM.Methods：In total,101 patients with hyperthyroidism were divided into hyperthyroidism with normal glucose tolerance （TNGT）,hyperthyroidism with impaired glucose regulation （TIGR）,and diabetes （TDM） groups.Furthermore,96 patients without hyperthyroidism were recruited as control groups （normal glucose tolerance [NGT],impaired glucose regulation [IGR],and T2DM）.The following parameters were evaluated：homeostasis model assessment （HOMA）-IR,HOMA-β,modified β-cell function index （MBCI）,peak insulin/fasting insulin （IP/I0）,AUCins-OGTT,and AUCins-OGTr/AUCglu-OGTT from the oral glucose tolerance test （OGTT） insulin release test were utilized to assess the second-phase insulin secretion,while the IP/I0,AIR0＇-10＇,and AUCins-IVGTT from the intravenous glucose tolerance test （IVGTT） insulin release test were used to assess the first-phase insulin secretion.Results：In the OGTT,the HOMA-β values of the TNGT and TDM groups were higher than those of the NGT and T2DM groups （all P 〈 0.05）.In the hyperthyroidism groups,the MBCI of the TDM group was lower than that of the TNGT and TIGR groups （all P 〈 0.05）.Among the control groups,the MBCI values of the IGR and T2DM groups were lower than that of the normal glucose tolerance （NGT） group （all P 〈 0.05）.In the IVGTT,insulin secretion peaked for all groups at 2-4 min,except for the T2DM group,which showed a low plateau and no secretion peak.The IPvalues of the TNGT,TIGR,and TDM groups were higher than those of the NGT,IGR,and T2DM groups （all P 〈 0.05）.The IP/I0,AIR0＇-10＇,and AUCins-IVGTT values of the TDM group were higher than those of the T2DM group but were lower than those of the TNGT,TIGR,NGR,and IGR groups （all P 〈 0.05）.Compared with the other five groups,the IP/I0 AIR0＇-10＇,and AUCins-IVGTT values of the T2DM group were significantly decreased （all P 〈 0.05）.The IP/I0 and AUCins-IVGTT values of the TNGT group were higher than those of the NGT group （all P 〈 0.05）.Conclusions：β-cell function in TDM patients is superior to that in T2DM patients.First-phase insulin secretion could be used as an early diagnostic marker to differentiate TDM and T2DM.