Glargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen
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Date
2017
Authors
Harrison, V. S.
Rustico, S.
Palladino, A.A.
Ferrara, C.
Hawkes, Colin P.
Journal Title
Journal ISSN
Volume Title
Publisher
Blackwell Publishing Ltd
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Abstract
Background: Diabetes ketoacidosis (DKA) is a common presentation and complication of type 1 diabetes (T1D). While intravenous insulin is typically used to treat acute metabolic abnormalities, the transition from intravenous to subcutaneous treatment can present a challenge. We hypothesize that co-administration of glargine, a subcutaneous long-acting insulin analog, during insulin infusion may facilitate a flexible and safe transition from intravenous to subcutaneous therapy. Objective: To determine if the practice of administering subcutaneous glargine during intravenous insulin is associated with an increased risk of hypoglycemia, hypokalemia, or other complications in children with DKA. Methods: Retrospective chart review of patients aged 2 to 21 years, presenting to our center with DKA between April 2012 and June 2014. Patients were divided into two groups: those co-administered subcutaneous glargine with intravenous insulin for over 4 hours (G+); and patients with less than 2 hours of overlap (G−). Results: We reviewed 149 DKA admissions (55 G+, 94 G−) from 129 unique patients. There was a similar incidence of hypoglycemia between groups (25% G+ vs 20% G−, P = 0.46). Hypokalemia (<3.5 mmol/L) occurred more frequently in the G+ group (OR = 3.4, 95% CI 1.7-7.0, P = 0.001). Cerebral edema occurred in 2/55 (3.6%) of the G− group and none of the G+ subjects. Conclusion: Co-administration of glargine early in the course of DKA treatment is well tolerated and convenient for discharge planning; however, this approach is associated with an increased risk of hypokalemia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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Keywords
Diabetes , Diabetic ketoacidosis , Glargine , Hypoglycemia , Insulin
Citation
Harrison, V. S., Rustico, S., Palladino, A. A., Ferrara, C. and Hawkes, C. P. (2017) ‘Glargine co‐administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen’, Pediatric Diabetes, 18(8), pp.742-748. doi: 10.1111/pedi.12462
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© 2016, John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Harrison, V. S., Rustico, S., Palladino, A. A., Ferrara, C. and Hawkes, C. P. (2017) ‘Glargine co‐administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen’, Pediatric Diabetes, 18(8), pp.742-748, doi: 10.1111/pedi.12462, which has been published in final form at: https://doi.org/10.1111/pedi.12462. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.