Use of a Flexible Catheter for the Administration of Subcutaneous Insulin in Diabetic Ketoacidosis: A Feasibility Controlled Clinical Trial

Abstract

BACKGROUND: Although intravenous insulin administration is the standard of care in diabetic ketoacidosis (DKA), subcutaneous insulin administration could be a suitable alternative in resource-limited settings, but pain caused by hourly insulin applications are limiting factors for using it, especially in children. We aimed to assess whether the use of a flexible subcutaneous catheter improves comfort in patients with DKA compared with the usual hourly injections’ treatment. We also compared the evolution of metabolic variables in patients with DKA using both insulin administration systems. METHODS: Randomized feasibility controlled open trial, comparing 2 ways (flexible catheter and steel needle) for the initial insulin administration in children with DKA, who were randomly selected to receive subcutaneous insulin by a flexible catheter or using standard needles. The main outcome was pain, assessed hourly and secondary outcome time to achieve ketoacidosis resolution. RESULTS: Twenty subjects were included (10 by group). There were no differences between groups in baseline lab values (glycemia, urea, sodium, bicarbonate and pH). Pain assessment at first insulin administration was significantly lower in the intervention group (4.5 vs 0 points; P = 0.001). Similar differences between both treatment arms were observed in every pain assessment. There were no differences between groups regarding the time elapsed to achieve ketoacidosis resolution. (11.4±4.3 vs 16±8.4; P = 0.12). No adverse events or DKA complications were observed. CONCLUSIONS: The use of a flexible catheter reduced the pain associated with subcutaneous insulin administration in nonsevere DKA. The flexible subcutaneous catheter could be a safe alternative for the treatment of uncomplicated DKA in resource-limited settings.

Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children

“…Although SC insulin does not require preparation and is easier to administer, the recurring injections every 2 hours can be painful and frustrating to the child and add to the discomfort caused by laboratory monitoring every 2 to 4 hours. The use of a flexible SC catheter can help to overcome this disadvantage of using SC insulin injection without affecting its efficacy . Moreover, the recent ISPAD guideline for management of DKA during COVID-19 raised concern about a possible increased burden on the nursing staff due to the frequent injections .…”

“…The use of a flexible SC catheter can help to overcome this disadvantage of using SC insulin injection without affecting its efficacy. 30 Moreover, the recent ISPAD guideline for management of DKA during COVID-19 raised concern about a possible increased burden on the nursing staff due to the frequent injections. 17 In our study, the SC insulin group had their DKA resolved 2.83 hours sooner than the IV group, therefore saving nursing effort in extracting blood for laboratory monitoring and continuing DKA monitoring and management.…”