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Table 4 Studies on insulin sensitivity and glycemic control

From: Bicarbonate in diabetic ketoacidosis - a systematic review

Reference Trial design and size Bicarb dose (intervention) Insulin dose Glycemic control
Hale et al. [13] RCT 150 mmol IM 20 U in 1st hr, No difference in glucose decline over 2 hr
Br Med J 1984 Adults (N = 32) (standard) 6 U in both 2nd and 3rd hr  
Morris et al. [14] RCT 120.4 mmol Insulin 0.3 U/kg (IV + IM), No difference in time for glucose to reach 250 mg/dL
Ann Intern M 1986 Adults (N = 21) (mean) then IM 7 U/hr No difference in total insulin required
     (1 hypoglycemia in control group)
Gamba et al. [15] RCT 84 mmol IV insulin 5 U/hr No difference in glucose levels throughout 24 hrs
Rev Cl In 1991 Adults (N = 20) (mean)   No difference in total insulin required to reduce glucose
     to < 250 mg/dL, or till urine ketones were < 2+
Lutterman et al. [17] Retrospective 167 mmol High-dose insulin (mean No difference in glucose decline in 1st 2 hrs
Diabetologia 1979 Adults (N = 24) (standard) 260 ± 60 U in 1st 6 hr) No difference in mean glucose in 1st 8 hours
    vs. low dose 8 U/hr (4 hypoglycemia in bicarb arm)
Lever et al. [18] Retrospective 130-135 mmol IM or IV insulin No difference in glucose decline in 7 - 9 hrs
Am J Med 1983 Adult (N = 73) (standard) 5-6 U/hr (for all) (2 hypoglycemia in bicarb arm)
Viallon et al. [20] Retrospective 120 ± 40 mmol IV insulin for all No difference in normalization time of glycaemia
Crit Care Med 1999 Adult (N = 39) (mean) (dose unspecified) OR in mean quantity of insulin infused
Green et al. [24] Retrospective 2.08 mmol/kg IV insulin for all No difference in insulin requirement in 24 hrs
Ann Em Med 1998 Pediatrics (N = 106) (mean) (dose unspecified)  
Okuda et al. [19] Prospective 200 mmol IV 0.1 U/kg bolus insulin No difference in glucose decline over 7 - 8 hrs
J Clin En M 1996 Adults (N = 7) (standard) and then IV 0.1 U/kg/hr  
  1. IM = intramuscular; IV = intravenous; U = units; bicarb = bicarbonate; L = liter; hr = hour