Subcutaneous Use of a Fast-Acting Insulin Analog An alternative treatment for pediatric patients with diabetic ketoacidosis

OBJECTIVE — To look for technical simplification and economic efficiency in the treatment of pediatric diabetic ketoacidosis (DKA) with subcutaneous use of the fast-acting insulin analog (lispro) and compare its use with regular intravenous insulin treatment. RESEARCH DESIGN AND METHODS — In this controlled clinical trial from June 2001 to June 2003, we randomized 60 episodes of DKA with a blood glucose level16.6 mmol/l (300 mg/dl), venous pH7.3 and/or bicarbonate15 mmol/l, or ketonuria greater than. Of the 60 episodes, 30 were treated with subcutaneous lispro (0.15 units/kg) given every 2 h (lispro group) and the other 30 cases received continuous intravenous regular insulin (0.1 unit kg1 h1; CIRI group). Volume deficit was repaired with 10-ml/kg aliquots of 0.9 % sodium chloride. Laboratory monitoring included hourly bedside capillary glucose, venous blood gas, -hydroxybutyrate, and electrolytes. Plasma blood glucose levels were measured on admission, 2 h after admission, when capillary blood glucose reached13.8 mmol/l (250 mg/dl), and 6, 12, and 24 h thereafter. RESULTS — Capillary glucose levels decreased by 2.9 and 2.6 mmol l1 h1 in the lispro and CIRI groups, respectively, but blood glucose fluctuated at different time intervals. In the CIR