Intravenous Insulin Infusion Rate and Its Impact on the Time to Resolution of Diabetic Ketoacidosis

Background : Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes that is highly prevalent in children and adolescents. Intravenous (IV) insulin infusion is the mainstay of DKA treatment in the intensive care unit; however, standard-dose (0.1 U/kg/h) insulin infusion increases the risk of cerebral edema. Objective : To compare the efficacy and safety of low-dose (0.05 U/kg/h) vs high-dose (0.1 U/kg/h) IV insulin infusion in children and adolescents treated for DKA. Materials and methods: Our randomized single-blind study included 86 patients aged 5 to 14 years urgently hospitalized with symptoms of DKA. Group 1 comprised 40 children who received IV insulin at the low rate (0.05 U/kg/h), whereas group 2 included 46 children who received IV insulin at the standard rate (0.1 U/kg/h). During the treatment we compared the time to DKA resolution and blood glucose level decrease to 15 mmol/L and recorded cases of hypoglycemia, hypokalemia, and papilledema. The MannWhitney test was used to determine whether differences were statistically significant. Results : There was no difference between groups 1 and 2 in DKA treatment duration. The blood glucose level was found to decline to 15 mmol/L more slowly in children who received IV insulin at 0.05 U/kg/h. Hypoglycemia, hypokalemia, and papilledema were more common in the standard-dose (0.1 U/kg/h) group. Conclusions : The low-dose IV insulin infusion (0.05 U/kg/h) is safer in terms of complications (cerebral edema) associated with pediatric DKA treatment in the intensive care unit and not inferior to the standard recommended dose (0.1 U/kg/h) in efficacy.