Sandbox: HS

Preinsulin era •The treatment modalities used for diabetic coma include blood transfusion, castor oil with potassium citrate, and saline solutions with sodium carbonate among other therapies.

1930–1950 •The usual practice was to use insulin in 20–100 units i.v. or s.c. bolus followed by 20 units s.c. every 30–60 min depending on glucosuria.

1950–1970s • In that period, the insulin was given as 2 units/kg bolus of crystalline insulin; up to 920 units in the first 7 h.

Early 1970s • Insulin was given as low-dose insulin regimens with Regular insulin 0.1 units/kg i.v. followed by 0.1–0.3 units/h i.v., s.c., or i.m.

1990s • Insulin was administered as 0.1 units/kg i.v. bolus, then 0.1 units/kg/h as continuous infusion until glucose level <13.8 mmol/L (250 mg/dL)

2004–2009 • ADA consensus for treatment of DKA and HHS in adult patients according to which Initial bolus (0.1 units/kg i.v.), followed by 0.1 units/kg/h until glucose <250 mg/dL, then reduce insulin by 50%