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Insulin infusion for diabetic children
Insights
Low-dose insulin infusion effectively manages diabetic children, including those with ketoacidosis and insulin resistance. This flexible approach aids in transitioning patients to subcutaneous insulin and provides predictable blood glucose control during surgery.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Diabetic ketoacidosis and insulin-refractory hyperglycemia present significant management challenges in children.
- Current treatment protocols may require optimization for flexibility and efficacy in pediatric diabetes care.
- Surgical procedures in diabetic children necessitate precise glycemic control.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose insulin infusion in managing pediatric diabetes.
- To explore the utility of continuous insulin infusion in reversing diabetic ketoacidosis and insulin resistance.
- To assess the role of low-dose insulin infusion in perioperative glycemic control for diabetic children.
Main Methods:
- A cohort of 10 diabetic children (aged 3.5-16.7 years) with ketoacidosis, insulin resistance, or undergoing surgery were treated with low-dose insulin infusion.
- Infusion rates were adjusted based on clinical condition, with a mean infusion rate of 2.9 units/h for ketotic subjects and 2.6 units/h for stabilization.
- Mean infusion duration was 33 hours, with an overall mean rate of 0.074 units/kg/h.
Main Results:
- Successful management was achieved in all 10 pediatric patients.
- The technique facilitated a smooth transition to subcutaneous insulin regimens after initial correction.
- Low-dose insulin infusion proved effective in breaking insulin-refractoriness and reversing ketoacidosis.
- Predictable blood glucose control was observed during major surgery.
Conclusions:
- Low-dose insulin infusion offers a flexible and effective strategy for managing complex diabetes cases in children.
- This method provides a valuable tool for reversing diabetic ketoacidosis and overcoming insulin resistance.
- Continuous insulin infusion enhances perioperative glycemic management in pediatric surgical patients.
Abstract:
Low-dose insulin infusion was used successfully in the management of 10 diabetic children aged 3.5 to 16.7 years (five ketoacidosis, four with insulin refractory hyperglycaemia, and one during elective surgery). The mean duration of infusion was 33 hours, with a mean infusion rate of 2.9 units/h for the ketotic subjects, and 2.6 units/h for those requiring stabilization. The over-all mean hourly rate per kg body weight was 0.074 units. Extension of the infusion time beyond that needed for the immediate correction of the hyperglycaemia and/or ketoacidosis enabled the smooth transition to a subcutaneous insulin regimen. Low-dose insulin infusion has introduced a new dimension of flexibility in the management of diabetes in the paediatric age group; the technique can be used to break the cycle of insulin-refractoriness as well as to reverse ketoacidosis. The surgeon can also anticipate a more predictable control of blood glucose level during major surgery when a continuous insulin infusion regimen is used.