title: Insulin glargine supplementation during early management phase of diabetic ketoacidosis in children.
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).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Pediatric intensive care unit of a university-based children's hospital.
  
  
  METHODS
  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>or=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.
authors.affiliation: Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA. vshankarmd@mac.com.
authors.forename: Venkat
authors.initials: V
authors.lastname: Shankar
authors.affiliation: Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA.
authors.forename: Anwarul
authors.initials: A
authors.lastname: Haque
authors.affiliation: Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Churchwell
authors.affiliation: Division of Pediatric Endocrinology, Monroe Carrell Jr. Children's Hospital at Vanderbilt, 37232, Nashville, TN, USA.
authors.forename: William
authors.initials: W
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine