Document Type
Article
Publication Date
8-2024
Identifier
DOI: 10.1111/1753-0407.13597; PMCID: PMC11320748
Abstract
BACKGROUND: Rebound hyperglycemia following the resolution of diabetic ketoacidosis (DKA) is common in pediatric patients with type 1 diabetes, increasing the risk of recurrent DKA and complicating the transition to subcutaneous insulin. Multiple studies suggest that early administration of long-acting insulin analogs during DKA management safely improves this transition.
OBJECTIVE: This study aimed to determine whether early insulin glargine administration in children with DKA prevents rebound hyperglycemia and recurrent ketosis without increasing the rate of hypoglycemia or hypokalemia.
METHODS: Patients agedChildren's Mercy Kansas City between October 2012 and October 2016 were reviewed. They were categorized as Early (>4 h of overlap with intravenous [IV] insulin) and Late (overlap) cohorts.
RESULTS: We reviewed 546 DKA admissions (365 Early and 181 Late). Rebound hyperglycemia (>180 mg/dL) was lower in the Early group (66% vs. 85%, p ≤ 0.0001). Hypoglycemia (/dL) during IV insulin administration was higher in the Early group than in the Late group (27% vs. 19%, p = 0.042). Hypoglycemia within 12 h of IV insulin discontinuation was lower in the Early group (16% vs. 26%, p = 0.012). Recurrent ketosis, hypokalemia, and cerebral edema were not different between the groups.
CONCLUSIONS: Early glargine administration in pediatric DKA management is safe, decreases the rate of rebound hyperglycemia, and improves the transition to subcutaneous insulin. Hypoglycemia is less frequent following IV insulin discontinuation with early glargine, but the IV insulin rate may need to be reduced to minimize hypoglycemia during IV insulin infusion.
Journal Title
J Diabetes
Volume
16
Issue
8
First Page
13597
Last Page
13597
MeSH Keywords
Humans; Insulin Glargine; Diabetic Ketoacidosis; Child; Male; Female; Adolescent; Hypoglycemic Agents; Diabetes Mellitus, Type 1; Retrospective Studies; Child, Preschool; Blood Glucose; Treatment Outcome; Hypoglycemia; Hyperglycemia
Keywords
diabetic ketoacidosis; glargine; hypoglycemia; rebound hyperglycemia; recurrent ketosis
Recommended Citation
Ohman-Hanson R, Alonso GT, Pyle L, McDonough R, Clements M. Management of diabetic ketoacidosis in children: Does early insulin glargine help improve outcomes?. J Diabetes. 2024;16(8):e13597. doi:10.1111/1753-0407.13597
Comments
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher's Link: https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13597