Comparison of Efficacy of Human and Porcine Insulin in Treatment of Diabetic Ketoacidosis

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Abstract
The efficacy of semisynthetic human insulin (HI) and monocomponent porcine insulin (PI) in treatment of diabetic ketoacidosis (DKA) was compared in 10 (PI) and 11 (HI) patients in a double-blind randomized study. Insulin (8 U/h i.v.), fluid replacement (0.65% NaCl and 5% glucose), and KCl supplements were administered according to a fixed protocol. Glucose, potassium, sodium, creatinine, calcium, phosphate, and free-insulin concentrations were never significantly different during the study. At the start, mean ± SD of pH was 7.10 ± 0.14 in the HI group and 7.10 ± 0.12 in the PI group. The time to reach arbitrary values for pH, bicarbonate, base excess, and β-hydroxybutyrate was shorter during HI treatment, but the differences were not statistically significant. During HI treatment, the arbitrary value of 1.0 mM of acetoacetate was reached faster than during PI treatment (5.2 ± 2.6 and 8.4 ± 0.9 h, respectively; P < .05). The concentration of acetoacetate was significantly different between the two groups after 6 and 7 h of insulin treatment (6 h: HI 0.82 ± 0.50 mM and PI 2.19 ± 1.65 mM, P < .05; 7 h: HI 0.51 ± 0.40 mM and PI 1.74 ± 1.54 mM, P = .05). We conclude that recovery from DKA during treatment with HI might be slightly faster than during treatment with PI. If this difference is real, it does not seem clinically important.

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