Diabetes ketoacidosis is the most important acute complication of diabetes mellitus. It is common, life threatening and reversible. (P. 812)Well, it is International Congress. Every country share own experience how to treat diabetics. In this presentation it was presented that low dose of insulin will suite the problem. Really?
38 diabetics were admitted to the hospital 50 times for ketoacidosis. 6 diabetics were admitted twice, 3 diabetics were admitted 3 times. Why not all 38 had more admissions then two or three? Probably because of they died, so complication was reversed completely. My ugly humor. The level of sugar from 310 mg/dl to 1250 mg/dl. It is not my humor. Still, it is ugly.
Management: 10 units of insulin intravenously + 10 units intramuscularly, and then 10 units every an hour till blood sugar will be less then 300 mg/dl.
Actually, this was before 1979, so long time ago. But what I do pay attention more then anything is, after first time when diabetic discharged from hospital, diabetic returned to the same hospital in the same condition, why? Right in the begging of the presentation authors said, it is reversible. Then why they did not reverse it? Why, this condition, life threatening, is "COMMON"? Only because of there is no treatment for diabetics.
Before first shot of Isletin (first name for insulin given to substance by discoverer Dr. Banting) was given to human, there were many dogs who treated with insulin. Dr. Banting and his assistant C.Best got the amount of substance to keep dog sound and out of insulin reaction, low blood sugar. It took less then month for them to find out the dose to inject. Now in 1979 or today in 2017 our medical care not capable to find out what dose of insulin to inject to treat diabetics without swing from high to low and back to high, why? Ketoacidosis is "COMMON"! How it can be today, or even in 1979?
In most books I read addressed to diabetes treatment there are all the time management of COMA. But say me, why today Coma still in the diagnose and in the treatment option? Really why? With insulin, even first types of insulin were able to return diabetics back to life, and today types of insulin are so nice and purified, human insulin, why today Coma still diagnosed? Why today with so easy screening for diabetes, why today millions of Americans live with undiagnosed diabetes? Why today level of sugar still not vital? It is so easy to do, just cost one glucose strip, just $1, and every one with elevated level of sugar would be under care. Too easy. No one fancy to take this way.
Personally, I do not understand, how dripping of insulin can solve the problem with blood sugar control? What also do I see is, the level of sugar dropped down to the <300 mg/dl, and diabetic discharged from hospital. But after discharge the level of sugar going up, and diabetic return to hospital, or worse. In the presentation there is no real solution how to stop this cycle. For me it looks like they simple do not understand, we are not lab rats. We are human. We are not for medical care studies. Really, why cares. I read one study after another, and ... there is no one way I will take part in any studies. Just do not participate in any studies.
In situation like this I prefer to take low level of insulin dose, short acting Novolog, about 20 units, and inject it right away. Then right after inject another 20 or 40 units long acting insulin Lantus Solo Star. Then check up the level of sugar dropping, and inject low dose of long acting insulin, to keep level of sugar dropping. To avoid low blood sugar , diabetic have to have meal, not glucose but worm good meal ready to eat at any moment. Personally I prefer soup.
via Ravenvoron
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