443: CONTINUOUS INTRAVENOUS VS SUBCUTANEOUS INSULIN MANAGEMENT IN MILD TO MODERATE DIABETIC KETOACIDOSIS

Diabetic ketoacidosis is a well-known acute complication in patients with both type 1 andtype 2 diabetes mellitus. Although mortality has decreased considerably, it remains an importantcause for admission to intensive care units. Medical management includes intravenous fluidtherapy, insulin, correction of electrolyte abnormalities, and addressing the precipitating factorwhich in most cases is infection or non-compliance with insulin therapy. Usually patients withdiabetic ketoacidosis are admitted to the intensive care unit for continuous infusion of insulin;however, the development of rapid acting insulin analogues has made it possible to treatmild to moderate diabetic ketoacidosis with subcutaneous insulin. Although studies usingsubcutaneous insulin include only a small number of patients, this approach seems as effectiveas intravenous insulin infusions in patients with mild to moderate diabetic ketoacidosis. Diabeticeducation and close follow-up for patients admitted for diabetic ketoacidosis remain essentialto avoid recurrence and readmissions.Keywords: Diabetic ketoacidosis, acute complication in diabetes, rapid acting insulinanalogues, subcutaneous insulin in diabetic ketoacidosis

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The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis

American Journal of Internal Medicine ◽

10.11648/j.ajim.20160403.11 ◽

2016 ◽

Vol 4 (3) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

Magui Abdel Moneim Shalash

Keyword(s):

Diabetic Ketoacidosis ◽

Continuous Subcutaneous Insulin Infusion ◽

Insulin Infusion ◽

Subcutaneous Insulin

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Impact of Body Habitus on the Outcomes of Pediatric Patients With Diabetic Ketoacidosis

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-26.2.194 ◽

2021 ◽

Vol 26 (2) ◽

pp. 194-199

Author(s):

Brady S. Moffett ◽

Joseph Allen ◽

Mahmood Khichi ◽

Bonnie McCann-Crosby

Keyword(s):

Adverse Events ◽

Continuous Infusion ◽

Diabetic Ketoacidosis ◽

Pediatric Patients ◽

Subcutaneous Insulin ◽

Insulin Initiation ◽

Body Habitus ◽

Normal Body ◽

Beta Hydroxybutyrate ◽

New Onset

OBJECTIVE To determine whether obese and overweight pediatric patients with new onset diabetic ketoacidosis (DKA) treated with continuous infusion insulin have increased time to subcutaneous insulin initiation or adverse events as compared with patients with normal body habitus. METHODS A retrospective, cohort study was designed that included patients 2 to 18 years of age admitted with new onset DKA who received continuous infusion insulin from January 1, 2011, to December 31, 2017. Patients were stratified according to BMI percentile with the primary outcome of time to initiation of subcutaneous insulin. Secondary endpoints included time to minimum beta-hydroxybutyrate, and incidence of hypoglycemia or other adverse events. RESULTS A total of 337 patients (46.6% male, 9.6 ± 3.8 years of age) met study criteria. Patients were classified by body habitus as obese (7.7%, n = 26), overweight (7.1%, n = 24), normal body weight (58.8%, n = 198), or underweight (26.4%, n = 89), based on BMI percentile. Most patients were initiated on insulin at 0.1 unit/kg/hr (86.7%) for 16.7 ± 7.0 hours. Time from continuous infusion insulin initiation to subcutaneous insulin was not different between body habitus groups, nor was hypoglycemia or the use of mannitol (p > 0.05). Median time to lowest beta-hydroxybutyrate was greater for obese (26.4, IQR [13.9, 41.9]) and overweight (32.4, IQR [18.3, 47.0]) groups than for normal body habitus patients (16.5, IQR [12.3, 23.8]) (p < 0.05). CONCLUSIONS Time to subcutaneous insulin and adverse events was not associated with body habitus, but obese and overweight patients may have delayed beta-hydroxybutyrate clearance.

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