Fast-acting insulin OK for kids in diabetic crisis

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When children with Diabetes don’t get enough insulin, impurities can build up rapidly in the body and cause a medical emergency. However, Diabetic ketoacidosis, as the condition is called, can be treated effectively and relatively simply with a fast-acting insulin analog injected subcutaneously, a new study shows.

The current standard of treatment for diabetic ketoacidosis, or DKA, is continuous intravenous administration of insulin, which may require admission to an intensive care unit, Dr. Durval Damiani of Sao Paulo University Medical School in Brazil and colleagues note in the medical journal Diabetes Care.

The team conducted a study to compare the fast-acting insulin analog lispro to continuous intravenous regular insulin in pediatric patients with DKA.

Sixty children with DKA were randomly assigned to treatment with continuous regular insulin or lispro given every 2 hours, which was reduced to every 4 hours once blood sugar levels began to fall. All the children were given IV fluid replacement.

Blood glucose levels fell below danger levels within 6 hours after therapy began in both groups, the researchers report. However, acidosis and ketosis resolved somewhat more quickly in the continuous insulin group than in the lispro group.

This was likely due to a “less than optimum” administration schedule in the lispro group, Damiani and colleagues suggest, adding that smaller doses given at shorter time intervals may have been more effective.

Nonetheless, the lispro approach promises simplicity and cost savings. As the investigators say: “Protocols of DKA treatment with subcutaneous rapid-acting analogs represent a technical simplification and may lower the mean cost for hospitalization as the patient would not need either insulin pumps or a second intravenous line.”

SOURCE: Diabetes Care, August 2005. 

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