THE USE OF ANALOG INSULIN AND BLOOD KETONE LEVELS IN PATIENTS WITH TYPE 1 DIABETIC KETOACIDOSIS: A RETROSPECTIVE OBSERVATIONAL STUDY

RAHMI YOSMAR; AYU SEPTIYANTI; YONETA SRANGENGE

doi:10.22159/ijap.2025.v17s1.19

Authors

RAHMI YOSMAR Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas Padang-25175, Indonesia
AYU SEPTIYANTI Undergraduate Pharmacy Study Program, Faculty of Pharmacy, Universitas Andalas Padang-25175, Indonesia https://orcid.org/0000-0003-4150-876X
YONETA SRANGENGE Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas Padang-25175, Indonesia

DOI:

https://doi.org/10.22159/ijap.2025.v17s1.19

Keywords:

Type 1 diabetes mellitu, Ketoacidosis, Insulin, Ketone levels, Effect

Abstract

Objective: The objective of this study is to examine the sociodemographic factors associated with ketoacidosis events in these patients and describe the effect of analog insulin and blood ketone levels on the occurrence of ketoacidosis.

Methods: A retrospective observational study was conducted at Dr. M. Djamil Padang Hospital with a cross-sectional approach. Participants included in the study were all Diabetic Patients with Diabetic Ketoacidosis admitted from 2019 to 2023. The method employed was total sampling based on predefined inclusion and exclusion criteria. Data analysis was performed using univariate and bivariate methods and also, multivariate analysis is used to identify confounding factors. A descriptive analysis was presented for analog insulin and the blood ketone levels. Ethical approval for the study was obtained from Health Research Ethics Committee, Dr. M. Djamil Padang Hospital, West Sumatra, Indonesia (No: DP.04.03/D. XVI. XI/118/2024).

Results: 35 patients of type 1 diabetic ketoacidosis were included in this study. All patients were treated with analog insulin therapy, specifically a combination of Levemir and Novorapid. The predominant sociodemographic group comprised adolescents aged 10–18 y (62.8%), with a mean age of 12.4 y. The majority of patients were female (54.2%) and had a primary education level (80%). However, the findings revealed that 25 of the 35 patients (71.42%) achieved normal ketone levels after receiving analog insulin therapy, while 10 patients (28.57%) did not normalize their ketone levels. 85.7% patients had comorbidities which the majority are Urinary Tract Infections and Bronchopneumonia.

Conclusion: Analog insulin therapy was effective in normalizing blood ketone levels in 71.42% of patients, though 28.57% did not achieve normalization. Age have a partial impact on the normalization of blood ketone levels in diabetic ketoacidosis patients, while education level, gender and comorbidities show no significant influence.

References

Williams R. IDF diabetes Atlas. 9th ed. International Diabetes Federation; 2019. p. 4-150.

Williams R, Karuranga S, Malanda B, Saeedi P, Basit A, Besançon S. Global and regional estimates and projections of diabetes-related health expenditure: results from the international diabetes federation diabetes atlas, 9th edition. Diabetes Res Clin Pract. 9th ed.; 2020 Apr 1;162:108072. doi: 10.1016/j.diabres.2020.108072, PMID 32061820.

Tamara A. Relationship between degree of diabetic ketoacidosis and potassium levels. Pediatr Sari. 2020;22.

Alshami A, Purewal T, Douedi S, Alazzawi M, Hossain MA, Ong R. Effect of insulin pump use on diabetic ketoacidosis in type 1 diabetes mellitus: a matched cohort study. J Clin Med. 2021 Mar 1;10(5):898. doi: 10.3390/jcm10050898, PMID 33668749.

Blum L, Ekpenyong A. Diabetes FIP practice transformation programme on NCDs diabetes prevention, screening and management a handbook for pharmacists. In: Netherland; 2021.

Padila P, Andri J, Sartika A, Andrianto MB. Quality of life of diabetes mellitus patients. Asclepius Public Health Journal. JH. 2021 Dec 30;3(2):80-7.

Analis J, Kendari K, Putu N, Martini P, Parwati PA. Relationship between urine ketones and blood glucose in diabetes mellitus patients. Med Wira. 2023.

Trivanka VM, Rusmana WE. Pola penggunaan insulin terhadap pasien diabetes mellitus tipe 1 di instalasi farmasi rawat jalan rumah sakit X. J Health Sains. 2021 Nov 24;2(11):1529-33. doi: 10.46799/jhs.v2i11.340.

Razavi Z, Maher S, Fredmal J. Comparison of subcutaneous insulin aspart and intravenous regular insulin for the treatment of mild and moderate diabetic ketoacidosis in pediatric patients. Endocrine. 2018 Aug 1;61(2):267-74. doi: 10.1007/s12020-018-1635-z, PMID 29797212.

Dewata DG, Novida H, Aryati A. Profile of diabetic ketoacidosis patients at regional public hospital Dr. Soetomo in 2017. JBE. 2020 Sep 20;8(3):301. doi: 10.20473/jbe.V8I32020.301-309.

Schwarzfuchs D, Rabaev E, Sagy I, Zimhony Nissim N, Lipnitzki I, Musa H. Clinical and epidemiological characteristics of diabetic ketoacidosis in older adults. J Am Geriatr Soc. 2020 Jun 1;68(6):1256-61. doi: 10.1111/jgs.16376, PMID 32134118.

Han JM, Joo NS. Impact of exercise on the presence of urinary ketones based on Korea national health and nutrition examination survey data, 2014-2015. J Obes Metab Syndr. 2020;29(2):143-9. doi: 10.7570/jomes20001, PMID 32493836.

Wang A, Tian X, Zuo Y, Xu Q, Meng X, Chen P. Urine ketone bodies and adverse outcomes in patients with acute ischemic stroke or TIA. Atheroscler Plus. 2022 Apr 1;48:20-6. doi: 10.1016/j.athplu.2022.03.001, PMID 36644558.

Goetera W, Agung D. Management of ketoacidosis; 2010. p. 1-13.

Vidyasagar K, Chandrasekar B, Chhabra M, Bhansali A, Bansal D. Efficacy and safety of commonly used insulin analogues in the treatment of diabetic ketoacidosis: a bayesian indirect treatment comparison. Clin Ther. 2020 Aug 1;42(8):e115-39. doi: 10.1016/j.clinthera.2020.06.017, PMID 32798057.

Ying L, Zhang Y, Yin J, Wang Y, Lu W, Zhu W. Classic type 1 diabetes mellitus and fulminant type 1 diabetes mellitus: similarity and discrepancy of immunological characteristics and cytokine profile. Diabetes Metab Syndr Obes. 2021;14:4661-70. doi: 10.2147/DMSO.S334712, PMID 34876826.

Rizkina RD, Rizkia A, Widyantari DD, Syafinatunnajah G, Cristagalli G, Cristagalli G. Type 1 diabetes mellitus in children: diagnosis and management. J Biologi Tropis. 2023 Nov 2;23(1):104-11. doi: 10.29303/jbt.v23i4b.5820.

Raghupathy P. Diabetic ketoacidosis in children and adolescents. Indian J Endocrinol Metab. 2015;19(7) Suppl 1:S55-7. doi: 10.4103/2230-8210.155403, PMID 25941653.

Eledrisi MS, Alshanti MS, Shah MF, Brolosy B, Jaha N. Overview of the diagnosis and management of diabetic ketoacidosis. Am J Med Sci. 2006;331(5):243-51. doi: 10.1097/00000441-200605000-00002, PMID 16702793.

Giwa AM, Ahmed R, Omidian Z, Majety N, Karakus KE, Omer SM. Current understandings of the pathogenesis of type 1 diabetes: genetics to environment. World J Diabetes. 2020 Jan 15;11(1):13-25. doi: 10.4239/wjd.v11.i1.13, PMID 31938470.

Jaser SS. Family interaction in pediatric diabetes. Curr Diab Rep. 2011 Dec;11(6):480-5. doi: 10.1007/s11892-011-0222-y, PMID 21853415, PMCID PMC3370388.

Mekonnen GA, Gelaye KA, Gebreyohannes EA, Abegaz TM. Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study. PLOS One. 2022 Apr 5;17(4):e0264626. doi: 10.1371/journal.pone.0264626, PMID 35381004, PMCID PMC8982884.

Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb 1;43(2):349-57. doi: 10.2337/dc19-1168, PMID 31704689.

Madrigal MA, Lopez M, Sanchez A, Cao MJ, Castro MJ, Jiménez JM. Type 1 diabetes mellitus in pediatric patients and its impact on relationships in the family environment. Diabetes Metab Syndr Obes. 2020;13:4973-80. doi: 10.2147/DMSO.S281949, PMID 33364801.

Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006;35(4):725-51. doi: 10.1016/j.ecl.2006.09.006, PMID 17127143.

Veauthier B, Levy Grau B. Diabetic ketoacidosis: evaluation and treatment. Am Fam Phys. 2024 Nov;110(5):476-86. PMID 39556629.

Paul S, Sourav D, Anurag KS, Shivang M, Sumit R, Mahaveer S. Epidemiologic pattern and factors associated with adverse outcomes of diabetic ketoacidosis in medical intensive care units of a tertiary care center in India, Endocrine and Metabolic Science. Vol. 16; 2024.

Jamshaid AA, Kambalimath M, Waqas M. Acute kidney injury requiring haemodialysis in severe diabetic ketoacidosis: a case report. Diabetes Care Child Young People. 2022;11:DCCYP101.

Marker AM, Monzon AD, Goggin K, Clements MA, Patton SR. Parent perspectives on educational and psychosocial intervention for recent-onset type 1 diabetes in their school-age child: a qualitative study. Diabetes Spectr. 2021 May 1;34(2):166-74. doi: 10.2337/ds20-0058, PMID 34149257.