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Abstract

This case series evaluates the efficacy and safety of subcutaneous (SC) insulin Aspart administered every four hours for managing mild-to-moderate diabetic ketoacidosis (DKA) in COVID-19 patients, addressing a current evidence gap. We conducted a retrospective review of confirmed COVID-19 patients over 15 years old who developed mild to moderate DKA between July 2020 and October 2021. Insulin Aspart was administered at 0.4 units/kg SC every 4 hours, reduced to 0.2 units/kg when blood glucose (BG) decreased to/dL, and SC basal insulin was initiated at 0.15-0.2 units/kg at DKA diagnosis. A total of seven patients, with a mean age of 67.4±13.2 years, predominantly female (71.4%), and all with pre-existing type 2 diabetes mellitus, were analyzed. Initial biochemical parameters included BG of 449±157.3 mg/dL, HbA1c of 10.6±2.8%, pH of 7.34 (range, 7.26-7.45), beta-hydroxybutyrate of 4.0±1.5 mmol/L, and bicarbonate of 15.5±2.2 mmol/L. The time to resolution of hyperglycemia (BG/dL) and DKA was 8.0±3.1 and was 12.7±5.8 hours, respectively. During DKA resolution, one patient experienced hypoglycemia (47 mg/dL) and later developed recurrent DKA as COVID-19 infection worsened. Three deaths occurred due to COVID-19-related complications following DKA recovery. While SC insulin Aspart administered every four hours shows promise, careful monitoring for recurrent DKA and septic shock is essential for optimal management.

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