Objective: To evaluate the effect of higher than recommended initial subcutaneous regular insulin dosage on glycemic control in the first 48 hours of therapy after resolution of diabetic ketoacidosis (DKA).
Methods: Records of patients with DKA, hospitalized in the past 3 years [n=72, median age=8.0 (IQ 6.0-10.0 years), male:female ratio 1:0.75] were analyzed. The patients were designated into two groups according to the starting doses of subcutaneous regular insulin after resolution of DKA. Group 1 (n=26) received a median dose of 1.4 U/kg/day (1.3-1.5) and group 2 (n=46) received a median dose of 0.92 U/kg/day (0.8-1). Clinical and laboratory data were compared using standard statistical methods.
Results: The number of patients who experienced hypoglycemia (<50 mg/dL) were 2 (9.67%) in group 1 and none had symptomatic hypoglycemia. Episodes of blood glucose in the target range (100-200 mg/dl) were significantly higher in group1 than in group 2 (p=0.001) and the number of hyperglycemic episodes were significantly lower in group1 (p=0.001). The incidences of hypoglycemia and hyperglycemia between the two groups were not related to the age of presentation or the severity of disease at onset. Comparison of the glycemic variability indices between the 2 groups revealed the standard deviation to be 78.7 and 75.8 and coefficient of variation to be 0.36 and 0.29 respectively.
Conclusion: After resolution of DKA, a higher initial dose of 1.3-1.5 U/kg/day subcutaneous regular insulin is associated with better glycemic control in children without an increase in risk of hypoglycemia.