Pediatric Original

Intensive Care Medicine

, Volume 33, Issue 7, pp 1173-1178

Insulin glargine supplementation during early management phase of diabetic ketoacidosis in children

  • Venkat ShankarAffiliated withDivision of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower Email author 
  • , Anwarul HaqueAffiliated withDivision of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower
  • , Kevin B. ChurchwellAffiliated withDivision of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower
  • , William RussellAffiliated withDivision of Pediatric Endocrinology, Monroe Carrell Jr. Children’s Hospital at Vanderbilt

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Abstract

Objective

To study the effect of subcutaneous administration of insulin glargine on the rate of resolution of acidosis and intravenous insulin infusion requirement in children with moderate and severe diabetic ketoacidosis (DKA).

Study design

Retrospective cohort study.

Setting

Pediatric intensive care unit of a university-based children's hospital.

Patients

Children with moderate to severe DKA admitted between March 2001 and February 2003.

Results

The outcomes of children who received 0.3 units/kg of subcutaneous insulin glargine in the first 6 h of management in addition to the standard treatment (n = 12) were compared with those of children who received standard treatment alone (n = 59). Measured outcomes included dose of intravenous insulin required, duration of insulin infusion and acidosis correction time. The two groups were similar in demographics and severity of illness. The mean time for acidosis correction (venous pH ≥ 7.3) in the insulin glargine group was shorter than the standard therapy group (12.4 ± 2.9 h and 17.1 ± 6.2 h respectively, p < 0.001). The insulin infusion time was shorter in the insulin glargine group (14.8 ± 6.0 h vs 24.4 ± 9.0 h, p < 0.001). There was a trend towards shorter total hospital stay in the glargine group (3.2 ± 1.0 days vs 3.72 ± 1.06 days).

Conclusions

In our small series of children with moderate and severe DKA, supplementing with subcutaneous insulin glargine led to a faster resolution of acidosis without any adverse effects. This could potentially lead to a shorter need for insulin infusion and a shorter ICU length of stay.

Keywords

Diabetes mellitus Pediatric Diabetic ketoacidosis Insulin