Intensive Care Medicine

, Volume 33, Issue 7, pp 1173–1178 | Cite as

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

  • Venkat Shankar
  • Anwarul Haque
  • Kevin B. Churchwell
  • William Russell
Pediatric Original



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.


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


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


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).


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.


Diabetes mellitus Pediatric Diabetic ketoacidosis Insulin 


  1. 1.
    Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI (2004) ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 89:188–194PubMedCrossRefGoogle Scholar
  2. 2.
    Komulainen J, Lounamaa R, Knip M, Kaprio EA, Akerblom HK (1996) Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood Diabetes in Finland Study Group. Arch Dis Child 75:410–415PubMedCrossRefGoogle Scholar
  3. 3.
    Rewers A, Chase HP, Mackenzie T, Walravens P, Roback M, Rewers M, Hamman RF, Klingensmith G (2002) Predictors of acute complications in children with type 1 diabetes. JAMA 287:2511–2518PubMedCrossRefGoogle Scholar
  4. 4.
    Rosilio M, Cotton JB, Wieliczko MC, Gendrault B, Carel JC, Couvaras O, Ser N, Bougneres PF, Gillet P, Soskin S, Garandeau P, Stuckens C, Le luyer B, Jos J, Bony-Trifunovic H, Bertrand AM, Leturcq F, Lafuma A (1998) Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group. Diabetes Care 21:1146–1153PubMedCrossRefGoogle Scholar
  5. 5.
    Smith CP, Firth D, Bennett S, Howard C, Chisholm P (1998) Ketoacidosis occurring in newly diagnosed and established diabetic children.Acta Paediatr 87:537–541PubMedCrossRefGoogle Scholar
  6. 6.
    Levy-Marchal C, Papoz L, de Beaufort C, Doutreix J, Froment V, Voirin J, Czernichow P (1992) Clinical and laboratory features of type 1 diabetic children at the time of diagnosis. Diabet Med 9:279–284PubMedCrossRefGoogle Scholar
  7. 7.
    Curtis JR, To T, Muirhead S, Cummings E, Daneman D (2002) Recent trends in hospitalization for diabetic ketoacidosis in ontario children. Diabetes Care 25:1591–1596PubMedCrossRefGoogle Scholar
  8. 8.
    Hirasing RA, Reeser HM, de Groot RR, Ruwaard D, van Buuren S, Verloove-Vanhorick SP (1996) Trends in hospital admissions among children aged 0–19 years with type I diabetes in The Netherlands. Diabetes Care 19:431–434PubMedCrossRefGoogle Scholar
  9. 9.
    Maldonado MR, Chong ER, Oehl MA, Balasubramanyam A (2003) Economic impact of diabetic ketoacidosis in a multiethnic indigent population: analysis of costs based on the precipitating cause. Diabetes Care 26:1265–1269PubMedCrossRefGoogle Scholar
  10. 10.
    Monroe KW, King W, Atchison JA (1997) Use of PRISM scores in triage of pediatric patients with diabetic ketoacidosis. Am J Manag Care 3:253–258PubMedGoogle Scholar
  11. 11.
    Wagner A, Risse A, Brill HL, Wienhausen-Wilke V, Rottmann M, Sondern K, Angelkort B (1999) Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application. Diabetes Care 22:674–677PubMedCrossRefGoogle Scholar
  12. 12.
    McKeage K, Goa KL (2001) Insulin glargine: a review of its therapeutic use as a long-acting agent for the management of type 1 and 2 diabetes mellitus. Drugs 61:1599–1624PubMedCrossRefGoogle Scholar
  13. 13.
    Dunn CJ, Plosker GL, Keating GM, McKeage K, Scott LJ (2003) Insulin glargine: an updated review of its use in the management of diabetes mellitus. Drugs 63:1743–1778PubMedCrossRefGoogle Scholar
  14. 14.
    Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM (2003) Hyperglycemic crises in patients with diabetes mellitus. Diabetes Care 26(1):S109–S117PubMedCrossRefGoogle Scholar
  15. 15.
    Grimberg A, Cerri RW, Satin-Smith M, Cohen P (1999) The “two bag system” for variable intravenous dextrose and fluid administration: benefits in diabetic ketoacidosis management. J Pediatr 134:376–378PubMedCrossRefGoogle Scholar
  16. 16.
    Edge JA, Hawkins MM, Winter DL, Dunger DB (2001) The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 85:16–22PubMedCrossRefGoogle Scholar
  17. 17.
    Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N (2001) Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med 344:264–269PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Venkat Shankar
    • 1
  • Anwarul Haque
    • 1
  • Kevin B. Churchwell
    • 1
  • William Russell
    • 2
  1. 1.Division of Pediatric Critical Care MedicineSuite 5121 Doctors Office TowerNashvilleUSA
  2. 2.Division of Pediatric EndocrinologyMonroe Carrell Jr. Children’s Hospital at VanderbiltNashvilleUSA

Personalised recommendations