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March 27, 2007

Hyperglycemia and DKA, Insulin

Question from Ohio, USA:

Is injecting insulin into muscle instead of subcutaneous fat an acceptable way to bring down a high blood sugar level?


Before the days of I.V. insulin, I actually published a paper on IM (intramuscular) insulin for treating ketoacidosis. That said, rapid acting analogues are just that..rapid. I don’t know of a paper looking at this with analogues. They are a different era from Regular. I expect it is quicker, but is it worth the effort? Likely not.

With our much shorter needles, it is hard to give IM save in the skinniest of us. It might actually be impossible, but I wouldn’t push the issue with anyone. It won’t hurt, but with the analogues, I don’t even mention it. When sick I.V. insulin is the 21st century way.


[Editor’s comment: Back in 1975, in Diabetic Crises in Children Treated with Small Doses of Intramusclar Insulin, researchers demonstrated that intramuscular insulin injections were more effective in bringing down high blood sugars. Although they do not identify the specific insulin used, clearly, analogue insulins were not used. See also Early hypoglycaemia after accidental intramuscular injection of insulin glargine..