Insulin glargine supplementation during early management phase of diabetic ketoacidosis in children.
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.
Shankar
Venkat
V
Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA. vshankarmd@mac.com.
Haque
Anwarul
A
Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA.
Churchwell
Kevin B
KB
Division of Pediatric Critical Care Medicine, Suite 5121 Doctors Office Tower, 2200 Children's Way, 37232-9075, Nashville, TN, USA.
Russell
William
W
Division of Pediatric Endocrinology, Monroe Carrell Jr. Children's Hospital at Vanderbilt, 37232, Nashville, TN, USA.
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
D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine