Objectives: Subcutaneous (SC) insulin has been studied as an alternative to intravenous (IV) insulin to reduce resource consumption in the management of diabetic ketoacidosis (DKA). However, feasibility and safety of an SC protocol have not been demonstrated in a Canadian context.
Methods: In this retrospective cohort study we examined the association between IV and SC insulin treatment for DKA and time to anion gap (AG) closure and length of stay (LOS) in hospital at a large Canadian tertiary care centre in nonpregnant adults with mild to moderate DKA. Rates of hypoglycemia, hypokalemia, and AG reopening requiring intervention were compared between treatment groups.
Results: Compared with the SC-treated group, the IV group had a shorter time to AG closure (median time to AG closure 15.6 hours in the IV group vs 24.0 hours in the SC group, adjusted hazard ratio 0.65, 95% confidence interval [CI] 0.45 to 0.92, p=0.02). IV-treated patients had much higher rates of hypoglycemia (1.6% in SC treated vs 19.6% in IV treated). SC-treated patients had a much lower rate of hypokalemia compared with IV-treated patients (adjusted odds ratio 0.35, 95% CI 0.15 to 0.80, p=0.01). However, the groups had similar LOSs in hospital and rates of AG reopening requiring intervention.
Conclusions: These results suggest SC insulin is safe. Although it may take 8.4 hours longer to close the AG with SC insulin, there is less hypoglycemia and hypokalemia and no difference in LOS in hospital.
Keywords: acidocétose diabétique; diabetes; diabetic ketoacidosis; diabète; insuline intraveineuse; insuline sous-cutanée; intravenous insulin; subcutaneous insulin.
Crown Copyright © 2025. Published by Elsevier Inc. All rights reserved.