Summary
Thirty-two episodes of diabetic ketoacidosis in 30 children treated with conventional repeated s.c. injections of insulin every 4 h are compared with 18 episodes in 14 children treated with continuous i.v. insulin infusion. Fluid therapy, bicarbonate and potassium supplementation were essentially the same for both groups. Recovery as reflected in serum glucose, bicarbonate and the rate of rehydration, was smoother and more rapid in the children receiving continuous i.v. insulin, though the difference just failed to attain statistical significance in this small series of cases. There was, however, a marked difference in insulin administered (0.58 U/kg ± 0.05 SEM in the children treated with continuous i.v. insulin infusionvs 2.54 ± 0.27 SEM in the children treated with repeated s.c. injections). Hypoglycemia was noted in 11 and hypokalemia in 10 children on conventional insulin therapy given every 4 h s.c. In contrast, there was no hypoglycemia and only one case of hypokalemia with the i.v. insulin infusion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alberti K. G. M. M., Hockaday T. D. R., Turner R. C.: Small doses of intramuscular insulin in the treatment of diabetic ‘coma’ - Lancet2, 515, 1973.
Billingham A. J., Detter S. C., Lenfaut C.: The role of hemoglobin oxygen affinity and red cell 2,3-diphosphoglycerate in the management of diabetic ketoacidosis- Trans. Ass. Amer. Phycns8, 113, 1970.
Drash A.: Diabetes mellitus in childhood: a review - J. Pediat.78, 919, 1971.
Felig P.: Current concepts: diabetic ketoacidosis — New Engl. J. Med.290, 1360, 1974.
Kaufman I. A., Keller M. A., Nyhan W. L.: Diabetic ketosis and acidosis: the continuous infusion of low doses of insulin — J. Pediat.87, 846, 1975.
Kidson W., Casey J., Kraegen E., Lazarus L.: Treatment of severe diabetes mellitus by insulin infusion — Brit. med. J.2, 691, 1974.
Krumlick J. J., Ehrlich R. M.: Insulin and sodium bicarbonate treatment of diabetic ketoacidosis: a retrospective review — J. Pediat.83, 268, 1973.
Martin M. M., Martin A. L. A.: Obesity, hyperinsulinemia and diabetes mellitus in childhood — J. Pediat.82, 192, 1973.
Martin M. M., Martin A. L. A.: Continuous low-dose infusion of insulin in the treatment of diabetic ketoacidosis — J. Pediat.89, 560, 1976.
Ohman J. L. Jr., Marliss E. B., Aoki T. T., Munichoodappa C. S., Khanna V. V., Kozak G. P.: The cerebrospinal fluid in diabetic ketoacidosis — New Engl. J. Med.284, 283, 1971.
Page M. McB., Alberti K. G. M. M., Greenwood R., Gumaa K. A., Hockaday T. D. R., Lowy C., Nabarro J. D. N., Pyke D. A., Sönksen P. H., Watkins P. J., West T. E. T.: Treatment of diabetic coma with continuous low-dose infusion of insulin — Brit. med. J.2, 687, 1974.
Peterson L., Caldwell J., Hoffman J.: Insulin adsorbance to polyvinylchloride surfaces with implications for constant-infusion therapy — Diabetes25, 72, 1976.
Rohn R., MacLaren N. K.: Diagnosis and treatment of diabetic ketoacidosis — Pediat. Ann.4, 32, 1975.
Schwartz R.: The critically ill child: diabetic ketoacidosis and coma — Pediatrics47, 902, 1971.
Semple P. F., White C., Manderson W. G.: Continuous intravenous infusion of small doses of insulin in treatment of diabetic ketoacidosis — Brit. med. J.2, 694, 1974.
Sönksen P. H., Srivastava M. C., Tompkins C. V.: Growth hormone and cortisol responses to insulin infusion in patients with diabetes mellitus — Lancet2, 155, 1972.
Winegrad A. I., Clements R. S.: Diabetic ketoacidosis — Med. Clin. N. Amer.55, 899, 1971.
Author information
Authors and Affiliations
Additional information
Supported in part by P.H.S. General Research Support Grant No. RR 5360.
Rights and permissions
About this article
Cite this article
Martin, A.L.A., Martin, M.M. Continuous infusion of insulin vs repeated S.C. injections in the treatment of diabetic ketoacidosis in children. Acta diabet. lat 15, 81–87 (1978). https://doi.org/10.1007/BF02581010
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02581010