Related Experiment Video

Updated: Aug 6, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Insulin therapy during diabetic ketoacidosis in children

Francesca Cardella1

  • 1Paediatrics Diabetology Unit, University of Palermo, Palermo, Italy. f.cardella@libero.i

Acta Bio-Medica : Atenei Parmensis
|August 19, 2006
PubMed

Insights

Diabetic ketoacidosis (DKA) remains a pediatric emergency, occurring in 25-40% of new diabetes cases. Successful DKA treatment hinges on managing hydration, acidosis, and electrolytes, not just insulin therapy, to prevent cerebral edema.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Emergency Medicine

Background:

  • Diabetic ketoacidosis (DKA) is a critical pediatric emergency.
  • DKA complicates 25-40% of diabetes onset cases, particularly in non-compliant or acutely ill children.
  • Delayed recognition of DKA significantly impacts patient morbidity and mortality.

Purpose of the Study:

  • To review current literature on pediatric DKA management.
  • To address controversies in DKA pathophysiology and complications, especially cerebral edema.
  • To evaluate evolving insulin therapy strategies for pediatric DKA.

Main Methods:

  • Literature review of recent pediatric DKA guidelines and research.
  • Analysis of DKA pathophysiology, focusing on cerebral edema development.
  • Evaluation of insulin therapy protocols, including dosage and administration routes.

Main Results:

  • Controversies persist regarding DKA pathophysiology and cerebral edema.
  • Continuous intravenous insulin infusion (0.05-0.1 U/Kg/h) is the preferred therapy for pediatric DKA.
  • Effective DKA management relies heavily on rehydration, metabolic acidosis correction, and electrolyte balance.

Conclusions:

  • Pediatric DKA requires comprehensive management beyond insulin therapy.
  • Careful attention to fluid balance, acidosis correction, and electrolytes is crucial for successful DKA treatment.
  • Preventing cerebral edema is paramount in managing pediatric DKA.

Related Concept Videos

Diabetic Ketoacidosis l: Introduction01:25

Diabetic Ketoacidosis l: Introduction

DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...
Diabetic Ketoacidosis ll: Pathophysiology01:22

Diabetic Ketoacidosis ll: Pathophysiology

Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
Insulin Formulations: Types and Delivery01:27

Insulin Formulations: Types and Delivery

Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into rapid-acting...
Glucose Homeostasis: Pancreatic Islets and Insulin Secretion01:27

Glucose Homeostasis: Pancreatic Islets and Insulin Secretion

The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
Insulin and C-peptide are co-secreted in...