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Insulin resistance relates to DKA severity and affects insulin requirement in children with type 1 diabetes at onset
Concetta Mastromauro1, Nella Polidori1, Annalisa Blasetti1
1Department of Pediatrics, University of Chieti, Chieti, Italy.
Insights
Children with severe diabetic ketoacidosis (DKA) require higher insulin doses. Insulin sensitivity varies with DKA severity, influencing insulin needs in new-onset type 1 diabetes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Research
Background:
- Diabetic ketoacidosis (DKA) management relies on fluid and insulin therapy, with established dosage guidelines.
- However, factors influencing varying insulin dosages at diabetes onset, particularly insulin sensitivity, require further investigation.
Purpose of the Study:
- To investigate the relationship between DKA severity and insulin sensitivity states.
- To determine if these states influence insulin requirements at the onset of diabetes.
Main Methods:
- Retrospective analysis of 62 children newly diagnosed with type 1 diabetes and DKA.
- Classification into severe, moderate, and mild DKA groups.
- Calculation of Glucose Infusion Rate (GIR), Insulin Infusion Rate (IIR), and their ratio as insulin sensitivity indices.
Main Results:
- Insulin Infusion Rate (IIR) decreased, while GIR and GIR/IIR increased from severe to mild DKA groups (p < 0.01).
- Area Under the Curve (AUC) for insulin and glucose, and their ratio, showed similar trends.
- pH correlated negatively with IIR and AUC-Insulin, and positively with GIR/IIR and AUC-glucose/AUC-insulin ratio.
Conclusions:
- Severe DKA cases exhibit a higher insulin requirement compared to less severe cases.
- DKA severity is linked to significant differences in insulin sensitivity.
- These findings suggest the potential for tailored insulin therapy based on DKA severity in children with new-onset type 1 diabetes.
Background:
Fluid and insulin treatments are the cornerstones of DKA management and indications on dosages are available. However, according to possible confounding factors, relevant data are still required to explain the different insulin dosages adopted at diabetes onset, particularly based upon insulin sensitivity.
Objective:
We aimed to explore whether DKA severity is related to different insulin sensitivity states, thus resulting in different insulin requirement at diabetes onset.
Methods:
Retrospective data from hospital records of 62 newly diagnosed children with type 1 diabetes with DKA were analyzed. The population was divided into three groups: severe, moderate, and mild DKA. Anthropometric, laboratory test, insulin, and glucose administration data were analyzed. The Glucose Infusion Rate (GIR), Insulin Infusion Rate (IIR), and GIR/IIR were calculated and used as indexes of insulin sensitivity. The area under the curve (AUC) for insulin and glucose infusion was calculated.
Results:
Moving among the three groups, IIR decreased while GIR and GIR/IIR increased from severe to mild DKA group (all p < 0.01). A similar trend was documented for AUC-insulin and AUC-glucose as well as AUC-glucose/AUC-insulin ratio. The Spearman correlation showed a negative correlation between pH and both IIR and AUC-Insulin as well as a positive correlation between pH and both GIR/IIR and AUC-glucose/AUC-insulin ratio.
Conclusions:
Subjects with severe DKA have a higher insulin requirement compared to those with less severe DKA. Significant differences in terms of insulin sensitivity might be documented according to the severity of DKA, which might result in tailored insulin pH requirement in children with new onset type 1 diabetes.
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