Low-Dose Insulin: A Plea for Caution

Three recent reports¹²³promulgating continuous intravenous infusions of low-dose insulin (1.2 to 12.0 U per hour, with or without an initial priming dose of 0.5 to 12 U) as a safe, simple and effective method of treating diabetic ketoacidosis, coupled with favorable editorial reviews⁴⁵have resulted in premature acceptance and widespread use of this new regimen. Before these reports many centers had abandoned subcutaneous and intramuscular insulin in the early treatment of diabetic ketoacidosis.^67891011The variable rate of absorption from these sites in a disorder uniformly characterized by extracellular-fluid depletion and even overt shock increases the possibility that large depots.