title: Higher-Than-Conventional Subcutaneous Regular Insulin Doses Following Diabetic Ketoacidosis in Children and Adolescents
abstract: To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA).
  
  
  
  Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed.
  
  
  
  Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively).
  
  
  
  After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.
authors.affiliation: Dr. Behçet Uz Children's Hospital, Clinic of Pediatrics, İzmir, Turkey, Phone: +90 232 464 6167 E-mail: bagozlem78@yahoo.com.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Bağ
authors.forename: Selma
authors.initials: S
authors.lastname: Tunç
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Nalbantoğlu
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Ecevit
authors.forename: Aysel
authors.initials: A
authors.lastname: Öztürk
authors.forename: Behzat
authors.initials: B
authors.lastname: Özkan
authors.forename: Korcan
authors.initials: K
authors.lastname: Demir
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Type 1 diabetes mellitus; children adolescent.; initial doses; regular insulin