Effective use of saline-diluted subcutaneous glargine in very low birth weight babies with neonatal hyperglycemia

This case series documents two very low birth weight neonates who presented with spontaneous hyperglycemia even after discontinuation of steroids in a critical care setting. Despite attempts to regulate their glucose levels using intravenous insulin infusion as per standard protocol, we faced challenges with dosage adjustment and observed significant fluctuations in their blood sugar levels requiring frequent glycemic monitoring (every 2 hours). As hyperglycemia continued, we decided to switch to the subcutaneous route of administration and reduce the frequency of glycemic monitoring. However, due to weight-based insulin dose calculation, a very low insulin dose had to be administered necessitating insulin dilution. Due to unavailability of commercial diluents, we explored saline as a diluent for glargine based on acidic pH similarity between glargine and saline. We observed that the saline-diluted glargine administered subcutaneously was effective in managing hyperglycemia, and their blood glucose levels stabilized within the desired range requiring less frequent monitoring (every 6 hours).