ESPE Abstracts

Background: There is no specific guideline for management of children with type 1 diabetes just after diabetic ketoacidosis (DKA) treatment. There are different insulin dosage practices (from 0.8 to 2.0 U/kg per day) in different centres based on personal experiences.

Objective and hypotheses: To assess daily subcutaneous insulin requirements and frequency of hypoglycaemic events (blood glucose < 50 mg/dl) just after DKA treatment of children with type 1 diabetes.

Method: This was a cross-sectional study of 30 patients admitted to our hospital with the diagnosis of DKA between June 2013 and March 2015. All were placed on multi-daily injection of insulin and regular blood glucose monitoring after treatment for DKA. The initial dose of subcutaneous insulin was calculated by 1.5 U/kg perday (40% of the total dose for basal insulin with insulin glargine and 60% for bolus insulin with insulin lispro divided in three doses). Follow-up doses were adjusted according to blood glucose monitoring.

Results: The mean age of patients was 10.3±5.0 years (1.6–17.4), and 20 of patients were female. From the analysis, the mean daily insulin requirement gradually declined from 1.62±0.33 U/kg per day on 1st day to 1.25±0.33 U/kg per day on day 7th after treatment for DKA. Only one hypoglycaemic episode was observed during fasting in one patient and four postprandial hypoglycaemic episodes were observed in three patients. No severe hypoglycemia was detected.

Conclusion: Initial dose of 1.5 U/kg per day subcutaneous insulin just after DKA treatment was supposed to be fairly safe and sufficient for management of most of the patients with type I diabetes.