The use of an initial insulin bolus at the start of continuous intravenous insulin infusion (CII) in hyperglycemic emergencies remains variable in clinical practice, with uncertain clinical benefit. A retrospective, propensity score–matched study published in Diabetology International evaluated the association between bolus insulin administration at CII initiation and clinical outcomes in patients with hyperglycemic crises.

This single-center observational study included 99 patients with hyperglycemic emergencies treated with CII between April 2010 and December 2024. Propensity score matching identified 21 matched pairs of patients who received and did not receive an initial bolus, based on clinical and biochemical severity indicators. Outcomes assessed included hospital length of stay, time to discontinuation of CII, glycemic control parameters, insulin requirements, and serum potassium changes, analyzed using Wilcoxon rank-sum and chi-square tests.

Bolus insulin administration was not associated with improvements in hospital length of stay, time to CII discontinuation, or glycemic control. The bolus group demonstrated higher insulin use during treatment and greater variability in serum potassium levels (Δpotassium 1.2 [0.8-1.9] vs 1.0 [0.4-1.3] mmol/L; p=0.049). Rates of hypokalemia, mortality, and other adverse events were similar between groups.

These findings indicate that bolus insulin at CII initiation was not associated with improved clinical outcomes in patients with hyperglycemic emergencies.