Fast-acting insulin helps with diabetes emergency

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A fast-acting type of insulin called lispro is a safe and effective treatment for diabetic ketoacidosis (DKA), a potentially life-threatening condition that occurs when sugar levels get too high.

Unlike regular insulin, which is continuously pumped into the veins when treating DKA, lispro is given intermittently with shots. As a result, regular insulin therapy usually requires treatment in the intensive care unit, whereas lispro does not. For this reason, lispro has the potential to greatly reduce hospital costs. 

As reported in the American Journal of Medicine, Dr. Guillermo E. Umpierrez, from Emory University in Atlanta, and colleagues assessed the outcomes of 40 DKA patients who were treated with lispro or regular insulin.

All of the subjects in the regular insulin group were treated in the intensive care unit, whereas half the lispro subjects were treated on a standard hospital ward and half were treated in a step-down unit, which provides an intermediate level of care.

The time needed to correct the condition was comparable in each group—about 7 hours were required to normalize the high sugar levels and around 11 hours were needed to resolve the DKA.

The groups were also similar in terms of length of hospital stay, the amount of insulin used before DKA resolution, and the percentage of subjects with sugar levels that fell too low during treatment. No deaths occurred in either group.

The average hospitalization charge for DKA treated in the intensive care unit was $14,429, almost 40% higher than the charge for treatment with lispro outside of the intensive care unit--$8801.

The findings “raise interesting questions regarding the most cost-effective and labor-saving methods for treating a common disease in the hospital setting,” Dr. Romana M. Haas and Dr. Andrew R. Hoffman, from Stanford University in California, note in a related editorial.

“Since many cases of uncomplicated DKA are now being treated in emergency departments or overnight treatment units, it will be important to perform similar analyses in these settings.”

Lispro is marketed as Humalog by Indianapolis-based Eli Lilly & Co, which helped fund the study.

SOURCE: American Journal of Medicine, September 1, 2004.

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