Abstract
Purpose
To determine the effects/safety of subcutaneous injection of insulin analogues in treating uncomplicated mild and moderate diabetic ketoacidosis (DKA).
Methods
In this prospective study in 2022, 25 children with mild/or moderate DKA were enrolled. The main outcome measure was median time (hours) for resolution of ketoacidosis. Data recorded: clinical characteristics, severity of ketoacidosis and dehydration, blood glucose, sodium, potassium, creatinine, urine ketones, hospitalization’s duration and complications. Based on the degree of dehydration, fluid deficit was replaced by sodium chloride 0.45%. Insulin aspart 0.15 units/kg subcutaneous injections were performed every two hours in hospital outside ICU. Blood glucose was measured hourly and blood gases every two hours. Ketoacidosis was considered resolved when the patient did not have nausea/vomiting, was conscious and could eat, blood glucose was < 250 mg/dL, pH > 7.30, and/or HCO3 > 15 mmol/L.
Results
From 25 DKA participants (mean age 11.06 ± 3.89, range 4–17 years, 60% girls), 16 cases (64%) had established type 1 diabetes. Overall, 13 cases (52%) had mild ketoacidosis (average pH = 7.25) and 12 cases (48%) had moderate ketoacidosis (average pH = 7.15). The mean time to resolution of ketoacidosis was 11.24 hours. All but one participant met DKA recovery criteria without complications. Mild cases compared to moderate cases of DKA had shorter duration to resolution of DKA (p value = 0.04). Mean duration of hospitalization was 2.3 days. No electrolyte disturbances, hypoglycemia events, readmission or mortality, or other adverse effects were observed.
Conclusion
In children with mild and moderate DKA, subcutaneous insulin aspart administration was an effective, safe, and convenient treatment.