Severe ketoacidosis as the first manifestation of diabetes mellitus after age fifty.

Two women over the age of 50 years presented with ketoacidosis as the first manifestation of diabetes mellitus. The first patient failed to respond to a regimen of hourly intramuscular injections of regular insulin. She only improved when a continuous intravenous infusion of regular insulin was utilized. The second patient was treated with a continuous infusion of insulin for a prolonged period. Her course was uneventful. It is recommended that a regimen of continuous infusion of regular insulin be the treatment of choice in the management of older patients presenting with ketoacidosis at the time of diagnosis of diabetes mellitus.