Higher-than-conventional subcutaneous regular insulin doses in diabetic ketoacidosis in children and adolescents

Objective: 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). methods: 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. results: 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). conclusion: 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. © 2017 by turkish pediatric endocrinology and diabetes society.