Menzel R, Zander E, Jutzi E
Endokrinologie. 1976 Jun;67(2):230-9.
Twenty-one patients in severe diabetic coma were treated with small doses of insulin at a rate of 4.1 units per hour (total dose about 100 units per 24 hours). Using single doses of 4 to 10 units by the intravenous or intramuscular routes the fall of blood glucose was steady in all cases. In the treatment of diabetic coma this regimen of insulin administration has proved simple, safe and effective since 1946. Main dangers during recompensation of diabetic coma are: hypovolaemia with oliguria -- anuria, dysequilibrium syndrome with cerebral edema and hypokalaemia. Therefore early intensive and adequate intravenous fluid and electrolyte replacement is the most important part of treatment. Most of the cases in this study were undiagnosed diabetics (14) and elderly patients (9). Three patients older than 65 years and a 56-year old diabetic died. In this context the most important aspects of treatment to avoid death are: prevention of diabetic coma and adequate fluid and electrolyte replacement especially in geriatric patients.
21例重度糖尿病昏迷患者接受了小剂量胰岛素治疗，速度为每小时4.1单位（每24小时总剂量约100单位）。通过静脉或肌肉注射途径单次给予4至10单位胰岛素，所有病例的血糖下降均稳定。自1946年以来，在糖尿病昏迷的治疗中，这种胰岛素给药方案已被证明简单、安全且有效。糖尿病昏迷代偿期的主要危险包括：伴有少尿——无尿的低血容量、伴有脑水肿的失衡综合征和低钾血症。因此，早期强化和充分的静脉补液及电解质补充是治疗的最重要部分。本研究中的大多数病例为未确诊的糖尿病患者（14例）和老年患者（9例）。3例65岁以上患者和1例56岁糖尿病患者死亡。在此背景下，避免死亡的治疗最重要方面是：预防糖尿病昏迷以及充分的液体和电解质补充，尤其是在老年患者中。
