Low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes—an observational study

  1. R. Puttha1,
  2. D. Cooke1,
  3. A. Subbarayan1,
  4. E. Odeka2,
  5. I. Ariyawansa2,
  6. M. Bone3,
  7. I. Doughty4,
  8. L. Patel1,
  9. R. Amin1,*,
  10. on behalf of the North West England Paediatric Diabetes Network1

Article first published online: 6 JUL 2009

DOI: 10.1111/j.1399-5448.2009.00536.x

Issue

Pediatric Diabetes

Pediatric Diabetes

Volume 11, Issue 1, pages 12–17, February 2010

Additional Information

How to Cite

Puttha, R., Cooke, D., Subbarayan, A., Odeka, E., Ariyawansa, I., Bone, M., Doughty, I., Patel, L., Amin, R. and on behalf of the North West England Paediatric Diabetes Network (2010), Low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes—an observational study. Pediatric Diabetes, 11: 12–17. doi: 10.1111/j.1399-5448.2009.00536.x

Author Information

  1. 1

    Department of Endocrinology, Royal Manchester Children's Hospital, Manchester, UK

  2. 2

    Department of Paediatrics, The Pennine Acute Hospitals NHS Trust, Manchester, UK

  3. 3

    Department of Paediatrics, Booth Hall Children's Hospital, Manchester, UK

  4. 4

    Department of Paediatrics, St Mary's Hospital, Manchester, UK

*Dr Rakesh Amin, The Department of Endocrinology, Royal Manchester Children's Hospital Manchester, UK M27 4HA. Tel: +0161 9222584; Fax: +0161 9222583; e-mail: rakesh.amin@cmft.nhs.uk

Publication History

  1. Issue published online: 28 JAN 2010
  2. Article first published online: 6 JUL 2009
  3. Submitted 11 October 2008. Accepted for publication 16 April 2007

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Keywords:

  • acidosis;
  • cerebral oedema;
  • diabetic ketoacidosis;
  • paediatric;
  • type 1 diabetes

Puttha R, Cooke D, Subbarayan A, Odeka E, Ariyawansa I, Bone M, Doughty I, Patel L, Amin R. Low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes—an observational study

Objective: To compare low dose (0.05 units/kg/h) with standard dose (0.1 units/kg/h) intravenous insulin infusion for the treatment of diabetic ketoacidosis (DKA) in children with type 1 diabetes.

Study design: Data from five paediatric centres were compared in children who received 0.05 (41 episodes) or 0.1 units/kg/h (52 episodes).

Results: In the low vs. standard dose group, at 6 h following admission, the fall in blood glucose levels [11.3 (95% confidence interval 8.6 to 13.9) vs. 11.8 (8.4 to 15.2) mmol/L, p = 0.86] and rise in pH [0.13 (0.09 to 0.18) vs. 0.11 (0.07 to 0.15), p = 0.78] were similar. These changes were comparable between doses in relation to: severity of initial acidosis, children newly diagnosed with diabetes or aged less than 5 years. After adjustment for other clinical and biochemical covariates, insulin dose was unrelated to the change in pH and blood glucose levels at 6 h following admission. Comparisons of safety data, particularly in relation to abnormal Glasgow Coma Score, were inconclusive.

Conclusion: In this observational study, low dose was as effective as standard dose intravenous insulin infusion in the initial treatment (less than 6 h) of DKA in children with type 1 diabetes. A randomised controlled trial is required to show true equivalence between doses and to evaluate potential safety benefits.

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