ESPE Abstracts

Background: While some guidelines recommend 0.5–1.0 units/kg per day of subcutaneous insulin following resolution of diabetic ketoacidosis (DKA), up to 2 units/kg/day are used in various centers.

Objective and hypotheses: To test the hypothesis that higher initial insulin doses would be more efficient during first 48 h of subcutaneous insulin therapy after DKA in cases with new-onset type 1 diabetes.

Method: Records of patients presented with DKA in the last 3 years (n=76, median (25th–75th percentile) age=10.0 (6.0–12.0) years, M/F:44/32) were reviewed. Patients given high-dose subcutaneous regular insulin (≥1.0 units/kg per day) constituted Group 1 (n=46, median dose=1.39 (1.02–1.47)) while those treated with conventional-dose (<1.0 units/kg per day) constituted Group 2 (n=30, median dose=0.90 (0.82–0.95)). Clinical and laboratory data were collected and analyzed.

Results: Groups were similar regarding age, gender, pubertal status, HbA1c, insulin dose administered for DKA, and blood glucose levels at the start of subcutaneous insulin treatment. Median and minimum blood glucose levels of Group 1 in the first 48 h were significantly lower than that of Group 2 (230 (198–270) vs 266 (221–315), P=0.008 and 102 (85–151) vs 129 (105–199), P=0.043, respectively). The number of patients who experienced hypoglycemia (<70 mg/dl) were similar (Group 1, 7 (15.2%) vs Group 2, 2 (6.7%), P=0.469) and none had severe hypoglycemia. In Group 1, ratio of blood glucose levels in the target range (100–200 mg/dl) were higher and the number of measurements >200 mg/dl were lower compared to Group 2 (P=0.014 and P=0.004, respectively). Subcutaneous insulin doses (units/kg per day) administered in second day in both Group 1 (1.48 (1.19–1.71) and Group 2 (1.05 (0.97–1.17)) were significantly higher compared to starting doses (P<0.001 for both). Glycemic variability indices were similar among the groups.

Conclusion: After resolution of DKA, a dose of 1.0–1.5 u/kg per day regular insulin is associated with better glycemic control without increased risk of hypoglycemia.