SC Insulin Analog Effective in Pediatric Diabetic Ketoacidosis

Pediatric diabetic ketoacidosis (DKA) can be treated safely and effectively with a fast-acting insulin analog delivered subcutaneously. The current standard of treatment for DKA is continuous IV administration of insulin, which can require ICU admission, Dr. Durval Damiani of Sao Paulo University Medical School in Brazil. They conducted the current study to compare the fast-acting insulin analog lispro to continuous intravenous regular insulin (CIRI) in pediatric patients with DKA.

Sixty patients with DKA were randomized to 0.15 units/kg of lispro given every 2 hours or CIRI. When blood glucose levels neared 13.8 mmol/L, lispro shots were spaced to every 4 hours. All of the patients received 10 mL/kg aliquots of 0.9% sodium chloride to restore fluid volume, and insulin within 1 to 2 hours after rehydration was initiated.

DKA resolved without complications in all of the patients. Capillary blood glucose fell by 2.9 mmol/L per hour in the lispro group and 2.6 in the CIRI group, and dropped below 13.8 mmol/L within 6 hours after therapy began in both groups. While acidosis and ketosis in the CIRI group resolved within 6 hours after capillary glucose had dropped to 13.8 mmol/L, they did not resolve until the following 6-hour interval in the lispro group.

The slower resolution of acidosis and ketosis in the lispro group was likely due to a "less than optimum" administration schedule, the researchers note, adding that continued smaller doses given at shorter time intervals may have been more effective.
The researchers conclude: "Protocols of DKA treatment with subcutaneous rapid-acting analogs represent a technical simplification and may lower the mean cost for hospitalization as the patient would not need either insulin pumps or a second intravenous line."

Diabetes Care 2005;28:1856-1861.