Conference Resources | Abstracts
September 3
rd
– 6
th
, 2014 | Toronto, Canada |
248
P160
Subcutaneous regular insulin for the treatment of diabetic ketoacidosis in children
M. Cohen
1
, N. Leibovich
2
, A. Hadash
1
, N. Zuckerman-Levin
1
, I. Shavit
1
, N. Shehadeh
1
1
Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel,
2
Meir Medical Center, kfar
saba, Israel
Objectives:
DKA treatment protocols vary between medical centers, however low-dose intravenous
(IV) administration of regular insulin is the standard care for replacing insulin in most. A small number
of studies, the majority in adults, demonstrated subcutaneous injections of rapid acting insulin every 1-
2 hours to be a valid alternative. It is our current practice to administer sub-cutaneous regular insulin
(approximately 0.8-1 u/kg/day) every 4 hours when treating children with DKA and a pH>7.0. We
aimed to review our experience with sub-cutaneous regular insulin in the treatment of DKA in children
and evaluate the effectiveness and safety of such treatment.
Methods:
Charts of children treated with subcutaneous regular insulin for DKA at the pediatrics
department, Meyer Children´s Hospital, Rambam healthcare campus, Israel between 2007-2009, were
reviewed. Data regarding clinical characteristics at diagnosis, response to insulin treatment and
occurrence of complications were analyzed. Further data from 2010-2014 are currently being
analyzed.
Results:
Forty one children met inclusion criteria (21 females). Mean age was 10.6±3.8 years. Ten out
of 41 children presented with new onset type 1 diabetes mellitus. Mean time to resolution of
hyperglycemia (Glucose< 250mg/dl) was 8.5±6.3 hours and time to resolution of DKA (pH>7.30,
HCO3>15) was 15.0±13.1 hours. The mean total insulin dose until resolution of DKA was 0.5±0.3
(unit/kg). During the time between admission and DKA resolution no episodes of hypoglycemia or
arrhythmia were recorded. No incidents of brain edema or mortality occurred while in hospital.
Conclusions:
Subcutaneous regular insulin administered every 4 hours appears to be an effective
and safe alternative for the insulin treatment of DKA with pH>7.0 in children. Such treatment has the
potential to simplify insulin administration when compared to either IV or q1-2 hour subcutaneous
insulin and reduce both admission costs and patient inconvenience.
