Continuous low-dose infusion of insulin in the treatment of diabetic ketoacidosis in children

Twelve diabetic children—eight in ketoacidosis, three with insulin refractory hyperglycemia, and one postoperative patient—were treated with continuous, low-dose, intravenous infusion of insulin. The eight ketoacidotic children with a mean serum glucose concentration on admission of 631 mg/dl and bicarbonate value of 6.8 mM/l were given regular insulin, 0.1 U/kg, slowly by bolus injection followed by a sustaining infusion of 0.1 U/kg/hour. Plasma glucose concentration fell at a mean rate of 82 mg/dl/hour. Euglycemia with concomitant improvement in the metabolic disorder was achieved with a mean dose of insulin, 0.68 U/kg, given over four to 10 hours. Mean plasma insulin in those children who had not previously received insulin was 55 μU/ml, well within the normal physiologic range. Growth hormone and serum triglyceride levels, low initially, rose with insulin therapy before returning to control values. Continuous low-dose insulin infusion is simple, safe, and effective, avoids confusion and empiricism, and appears to be the method of choice for the treatment of diabetic ketoacidosis or insulin resistance.