Diabetic ketoacidosis historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]


Diabetic ketoacidosis (DKA) was described for the first time by Dreschfeld in 1886 and labelled as one of the sudden causes of death in diabetes mellitus. In 1971, it was found that the pathogenesis of DKA involved a deficiency of insulin and an excess of glucagon. In the 20th century major advances were made in the field of management of DKA, starting from the isolation and use of insulin in patients to the adjustment of doses of insulin to achieve optimum control of the disease.

Historical Perspective

  • The known history of diabetes dates back to the Egyptian era, and the first documented evidence was found in an Egyptian papyrus dating back to 1552 BC.
  • In 1886, Dreschfeld provided the first description of diabetic ketoacidosis (DKA) in the modern medical literature. He described it in one of his lectures on diabetic coma and labelled it as one of the sudden causes of death in diabetes.[1]
  • In 1971, DKA was referred to as a disorder involving insulin deficiency and glucagon excess.[2]

Landmark Events in the Development of Treatment Strategies

  • In 1922 insulin was discovered and isolated by Banting and Best, after which they used it to treat patients with diabetic ketoacidosis.
  • In 1945, a study was conducted and it was found that the mortality rate of diabetic ketoacidosis was reduced from to 12% in 1940 and to 1.6% by 1945, after the use of high doses of insulin.
  • In Birmingham, UK, high-dose insulin was also being used, leading to a decrease in overall mortality, with doses varying depending on the degree of consciousness, with those on admission given doses ranging between 500 to 1400 units per 24 hours.[3]
  • In early 1970's the concept of low dose insulin for the management of diabetic ketoacidosis was introduced.
  • The UK favored the use of insulin infusions of between 1.2 and 9.6 units per hour at a fixed rate during the management of diabetic ketoacidosis.[4]
  • In the USA, Kitabchi et al. employed a variety of regimens, based on body weight.[5]


  1. Dreschfeld J (1886). "The Bradshawe Lecture on Diabetic Coma". Br Med J. 2 (1338): 358–63. PMC 2256374. PMID 20751675.
  2. Fleckman AM (1993). "Diabetic ketoacidosis". Endocrinol. Metab. Clin. North Am. 22 (2): 181–207. PMID 8325282.
  3. Dhatariya KK, Vellanki P (2017). "Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA)". Curr. Diab. Rep. 17 (5): 33. doi:10.1007/s11892-017-0857-4. PMC 5375966. PMID 28364357.
  4. Fisher JN, Shahshahani MN, Kitabchi AE (1977). "Diabetic ketoacidosis: low-dose insulin therapy by various routes". N. Engl. J. Med. 297 (5): 238–41. doi:10.1056/NEJM197708042970502. PMID 406561.
  5. Kitabchi AE, Ayyagari V, Guerra SM (1976). "The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis". Ann. Intern. Med. 84 (6): 633–8. PMID 820228.

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