Higher-Than-Conventional Subcutaneous Regular Insulin Doses in Diabetic Ketoacidosis in Children and Adolescents

Abstract

Objective:To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA).Methods:Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed.Results:Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively).Conclusion:After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.

Determinants and Characteristics of Insulin Dose Requirements in Children and Adolescents with New-Onset Type 1 Diabetes: Insights from the INSENODIAB Study

“…Interestingly, in our INSENODIAB study, median TIDD d was 1.1 IU/kg BW/day (IQR 0.5) while the major guidelines recommend doses ranging from 0.5 to 1.0 IU/kg BW/day. This is in line with the work of Bag et al who showed that a higher insulin dose at diabetes onset is associated with better glycemic control in pediatric patients [ 37 ]. By using a higher TIDD, we did not provoke an increased rate of hypoglycemia (11.6%) as it was previously described in the literature [ 31 , 38 ].…”

“…Prior studies have documented that intensive insulin therapy can improve endogenous insulin secretion, leading to improved metabolic control [36] and an earlier regulation of blood glucose levels. Interestingly, in our INSENODIAB study, median TIDD d was 1.1 IU/kg BW/day (IQR 0.5) while the major guidelines recommend doses ranging from 0.5 to who showed that a higher insulin dose at diabetes onset is associated with better glycemic control in pediatric patients [37]. By using a higher TIDD, we did not provoke an increased rate of hypoglycemia (11.6%) as it was previously described in the literature [31,38].…”