Hypoglycaemi a as a complication of treatment of diabetic ketoacidosis

Abstract

Introduction. Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes which presents as hyperglycaemia, ketonemia and metabolic acidosis. Too large insulin doses used to start the DKA treatment and missing of early infusions of glucose solutions to prevent hypoglycaemia when glycaemia is 11–14 mmol/l are suppose to be the major causes of hypoglycaemia. Aim. To determine the predisposing factors of hypoglycaemia during DKA treatment. Materials and methods. An analysis of data of retrospective cohort study of 67 patients treated for DKA at ICU of Hospital of Lithuanian University of Health Sciences (HLUHS) during 2012–2016 (Bioethic‘s licence Nr. BEC – MF – 492) has been performed. Glucose level in blood, hypoglycaemia episodes, insulin dosage, infusion therapy with glucose solutions have been analysed. SPSS 23.0 has been used for statistic calculations. For statistic data analysis χ2 trait dependency test and calculation of data numerical characteristics have been used. Traits evaluated as significant as p < 0.05. Results. 15 episodes of hypoglycaemia in 11/67 (16.4 %) cases were found during the insulin treatment of DKA. Glucose level in the blood has varied in range of 1.2–3.3 mmol/l (2.5 ± 0.7 mmol/l). Treatment of DKA with larger 3–8 U/h (4.5 ± 1.2 U/h) insulin doses was initiated in 42/67 (62.7 %) patients (pts), of which hypoglycaemia occured in 9/42 (21.4 %) cases. Statistically significant dependency has been found between treatment with larger doses of insulin and development of hypoglycaemia (p < 0.05). Excessive 3–6 U/h dosage (3.7 ± 0.8 U/h) of insulin when glycaemia level was ≤ 11 mmol/l has been continued in 24/42 (57.1 %) pts, in 7/24 (29.2 %) of them hypoglycaemia has developed. Statistically significant dependency has been found between treatment with larger doses of insulin, when glycaemia level was ≤11 mmol/l, and development of hypoglycaemia (p < 0.05).[...].