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Henry T. Ricketts, MD

JAMA. 1975;231(12):1230.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In the article dealing with hyperosmolar, nonketotic syndrome and steroid diabetes after renal transplantation (p 1261), the authors describe a seriously ill patient with a plasma glucose level of 1,526 mg/100 ml and near coma, without ketosis. She was treated with, among other things, "massive doses of insulin zinc suspension, extended (1,085 units in 24 hours)," but her coma deepened through the next three hours. Insulin zinc suspension, extended, is the slowly acting, protracted insulin known as ultrainsulin.

Use of this insulin under these circumstances was an error. The patient should have had regular insulin, with its prompt action, from the start. This is the preferred treatment for any seriously ill diabetic patient, no matter what the cause.

It is true that most patients with hyperosmolar, nonketotic syndrome do not require as large doses as those with ketoacidosis, but therapy should be started with regular insulin in . . . [Full Text PDF of this Article]

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