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Risk of ketosis during intensive insulin therapy in pre-school-age diabetic children
Insights
Continuous subcutaneous insulin infusion improved blood glucose control in young diabetic children. Insulin pump therapy did not increase ketosis risk, but vigilant monitoring is crucial due to potential device failures and rapid ketosis development.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Type 1 diabetes in pre-school-age children presents unique management challenges.
- Intensified diabetes therapy aims for stable blood glucose control in young children.
- Conventional insulin therapy showed limited efficacy in this cohort.
Purpose of the Study:
- To evaluate the risk of ketosis with different insulin therapy modes in young diabetic children.
- To assess the impact of continuous subcutaneous insulin infusion (CSII) versus conventional therapy on ketosis.
- To determine the safety and efficacy of insulin pump therapy in pre-school-aged diabetic children.
Main Methods:
- A subset of five pre-school-age diabetic children with poor initial response underwent intensified therapy.
- Optimized conventional insulin therapy was used for 16 months.
- Treatment was switched to continuous subcutaneous insulin infusion (insulin pump therapy).
- Metabolic changes were monitored, including blood glucose, ketonuria, and diabetic ketoacidosis (DKA).
- In-hospital cessation of insulin therapy was performed to assess metabolic response.
Main Results:
- Conventional therapy failed to significantly improve blood glucose control and was associated with frequent ketonuria and DKA episodes.
- Continuous subcutaneous insulin infusion rapidly improved blood glucose control without increasing ketosis or DKA frequency.
- Most ketosis events occurred early in insulin pump therapy.
- Deliberate insulin cessation under supervision induced similar metabolic changes (increased blood glucose, elevated 3-hydroxybutyrate, ketonuria) in both therapy groups.
- Insulin pump therapy was not associated with increased ketosis frequency or accelerated development.
Conclusions:
- Continuous subcutaneous insulin infusion is a safe and effective intensified therapy for young diabetic children, improving glycemic control.
- Insulin pump therapy does not increase the risk of ketosis in this age group.
- Parents require education on vigilance for potential device failures and prompt recognition of ketosis, emphasizing regular urine ketone testing and insulin supplementation.
Abstract:
The risk of ketosis and its relationship to the mode of insulin therapy were studied in a subset of pre-school-age diabetic children. These five children, who initially responded poorly to standard in-hospital diabetes management, were selected for a program of intensified therapy directed at achieving more stable blood glucose control. Optimized conventional therapy was first employed for 16 +/- 5 mo and did not improve substantially blood glucose level or stability. During this period, there was an average of almost one episode of ketonuria per patient per month, and three diabetic ketoacidosis episodes were observed. Because of its limited efficacy, the treatment was then changed to continuous subcutaneous insulin infusion. This mode of therapy had a rapid favorable effect on blood glucose control, with no concomitant increase of the frequencies of ketonuria or diabetic ketoacidosis, most of which occurred during the first months of insulin pump therapy. Deliberate cessation of either conventional or subcutaneous insulin infusion therapy for 7 h under close in-hospital control resulted in similar metabolic changes: a slight nonconstant increase of blood glucose, and an abrupt rise of blood 3-hydroxybutyrate to 3 mM, with massive ketonuria. The management of these young diabetic children with insulin pump therapy was thus not associated with an increased frequency or an accelerated rate of development of ketosis. However, the possible failures originating from the infusing device and the rapid increase of ketosis in young ages require special vigilance from the parents, based on twice-daily urine testing for ketones and appropriate insulin supplementation.