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Immediate metabolic response to a low dose of insulin in children presenting with diabetes
Insights
Lower initial doses of intramuscular insulin (0.1-0.5 units/kg) appear safer for treating childhood diabetes and ketoacidosis, showing effective glucose reduction without hypoglycemia.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Pharmacology
Background:
- Childhood diabetes mellitus requires careful insulin management.
- Diabetic ketoacidosis in children is a critical condition often treated with high-dose insulin.
- Current treatment protocols for diabetic ketoacidosis may involve risks.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose intramuscular insulin for new-onset and ketoacidotic diabetes in children.
- To compare this approach with currently recommended higher insulin doses.
Main Methods:
- Seventeen new childhood diabetes cases received initial intramuscular insulin (0.29 units/kg).
- Three children with diabetic ketoacidosis received low-dose intramuscular insulin (0.1-0.5 units/kg).
- Blood glucose, ketones, and plasma insulin levels were monitored.
Main Results:
- New cases showed a mean blood glucose fall of 88 mg/100 ml/hour and reduced ketones.
- Ketoacidosis cases had a mean blood glucose fall of 73 mg/100 ml/hour post-insulin.
- No hypoglycemia or hypokalemia was observed in treated children.
Conclusions:
- Low-dose intramuscular insulin (0.1-0.5 units/kg) may be a safer alternative for pediatric diabetic ketoacidosis.
- This approach can effectively lower blood glucose and ketone levels.
- Prioritizing rehydration remains crucial in managing diabetic ketoacidosis.
Abstract:
Seventeen new cases of diabetes in childhood were given an initial mean dose of insulin of 0-29 unit/kg body weight by intramuscular injection (mean age of patient 7-4 years). This resulted in a fall in blood glucose over the first 2 hours at a mean rate of 88 mg/100 ml per hour. Over the same time the mean total blood ketones fell from 3-23 to 2-3 mmol; and plasma insulin levels rose from a mean of 6 muU/ml to a mean of 65 muU/ml. Thus, with this small initial dose of insulin the 2-hour plasma insulin values were within the range which in adults has been associated with a maximum fall in blood glucose concentration. Three children with established diabetes presenting with ketoacidosis were also treated with a small initial dose of intramuscular insulin, 0-1 unit/kg in 2 of the patients and 0-5 unit/kg in the third. In 2 during a period of rehydration before insulin was given, blood glucose fell at a rate of 100 mg/100 ml per hour. Over the 2 hours after the initial dose of insulin the mean rate of fall of blood glucose for all 3 patients was 73 mg/100 ml per hour. None of these children developed hypoglycaemia nor hypokalaemia during treatment. We conclude that an initial intramuscular injection of soluble insulin in the dose range of 0-1-0-5 units/kg body weight may be more appropriate and possibly safer for the treatment of diabetic ketoacidosis in children than the currently recommended larger doses divided between intravenous and intramuscular routes. Adequate rehydration must, however, remain the first priority in the management of such cases.