The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis

Ann Intern Med. 1976 Jun;84(6):633-8. doi: 10.7326/0003-4819-84-6-633.


The effect of low-dose intramuscular insulin therapy was compared with that of high-dose insulin therapy by intravenous and subcutaneous routes in 48 patients with diabetic ketoacidosis. A simplified protocol was devised to compare efficacy of the two methods of therapy in a randomized manner. Plasma glucose dropped to less than 250 mg/dl in the low-dose group in 6.7 +/- 0.8 h and in the high-dose group in 4.5 +/- 0.8 h (P = not significant). The amount of insulin necessary to lower plasma glucose to 250 mg/dl was 263 +/- 45 U in the high-dose group and 46 +/- 5 U in the low-dose group. Twenty five percent in the high-dose group and none in the low-dose group developed hypoglycemia. Other biochemical and clinical variables in the two groups were comparable. No treatment complications were noted in the low-dose group. Our studies suggest that low-dose intramuscular insulin therapy is simple and as effective as high-dose therapy in the treatment of diabetic ketoacidosis without the risk of hypoglycemia and with a diminished incidence of hypokalemia. Furthermore, the favorable response of these patients to low-dose insulin therapy suggests the absence of insulin resistance in diabetic ketoacidosis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / drug therapy*
  • Humans
  • Hypoglycemia / etiology
  • Injections, Intramuscular
  • Injections, Intravenous
  • Injections, Subcutaneous
  • Insulin / administration & dosage*
  • Insulin / blood
  • Insulin / therapeutic use
  • Insulin Resistance
  • Middle Aged
  • Potassium / blood
  • Prospective Studies


  • Blood Glucose
  • Insulin
  • Potassium