Glargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen
dc.contributor.author | Harrison, V. S. | |
dc.contributor.author | Rustico, S. | |
dc.contributor.author | Palladino, A.A. | |
dc.contributor.author | Ferrara, C. | |
dc.contributor.author | Hawkes, Colin P. | |
dc.contributor.funder | National Children's Research Centre | en |
dc.contributor.funder | National Institutes of Health | en |
dc.date.accessioned | 2022-01-27T10:52:17Z | |
dc.date.available | 2022-01-27T10:52:17Z | |
dc.date.issued | 2017 | |
dc.description.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 | en |
dc.description.sponsorship | National Children's Research Centre, Dublin, Ireland (PhD grant); National Institutes of Health (Grant DK063688) | en |
dc.description.status | Peer reviewed | en |
dc.description.version | Accepted Version | en |
dc.format.mimetype | application/pdf | en |
dc.identifier.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 | en |
dc.identifier.doi | 10.1111/pedi.12462 | |
dc.identifier.endpage | 748 | |
dc.identifier.issn | 1399-543X | |
dc.identifier.issued | 8 | |
dc.identifier.journaltitle | Pediatric Diabetes | en |
dc.identifier.startpage | 742 | |
dc.identifier.uri | https://hdl.handle.net/10468/12489 | |
dc.language.iso | en | en |
dc.publisher | Blackwell Publishing Ltd | en |
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.subject | Diabetes | en |
dc.subject | Diabetic ketoacidosis | en |
dc.subject | Glargine | en |
dc.subject | Hypoglycemia | en |
dc.subject | Insulin | en |
dc.title | Glargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen | en |
dc.type | Article (peer-reviewed) | en |
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