Glargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen

dc.contributor.authorHarrison, V. S.
dc.contributor.authorRustico, S.
dc.contributor.authorPalladino, A.A.
dc.contributor.authorFerrara, C.
dc.contributor.authorHawkes, Colin P.
dc.contributor.funderNational Children's Research Centreen
dc.contributor.funderNational Institutes of Healthen
dc.date.accessioned2022-01-27T10:52:17Z
dc.date.available2022-01-27T10:52:17Z
dc.date.issued2017
dc.description.abstractBackground: 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 Ltden
dc.description.sponsorshipNational Children's Research Centre, Dublin, Ireland (PhD grant); National Institutes of Health (Grant DK063688)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationHarrison, 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.12462en
dc.identifier.doi10.1111/pedi.12462
dc.identifier.endpage748
dc.identifier.issn1399-543X
dc.identifier.issued8
dc.identifier.journaltitlePediatric Diabetesen
dc.identifier.startpage742
dc.identifier.urihttps://hdl.handle.net/10468/12489
dc.language.isoenen
dc.publisherBlackwell Publishing Ltden
dc.rights© 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.en
dc.subjectDiabetesen
dc.subjectDiabetic ketoacidosisen
dc.subjectGlargineen
dc.subjectHypoglycemiaen
dc.subjectInsulinen
dc.titleGlargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimenen
dc.typeArticle (peer-reviewed)en
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