Continuous infusion of insulin vs repeated S.C. injections in the treatment of diabetic ketoacidosis in children

Abstract

Thirty-two episodes of diabetic ketoacidosis in 30 children treated with conventional repeated s.c. injections of insulin every 4 h are compared with 18 episodes in 14 children treated with continuous i.v. insulin infusion. Fluid therapy, bicarbonate and potassium supplementation were essentially the same for both groups. Recovery as reflected in serum glucose, bicarbonate and the rate of rehydration, was smoother and more rapid in the children receiving continuous i.v. insulin, though the difference just failed to attain statistical significance in this small series of cases. There was, however, a marked difference in insulin administered (0.58 U/kg +/- 0.05 SEM in the children treated with continuous i.v. insulin infusion vs 2.54 +/- 0.27 SEM in the children treated with repeated s.c. injections). Hypoglycemia was noted in 11 and hypokalemia in 10 children on conventional insulin therapy given every 4 h s.c. In contrast, there was no hypoglycemia and only one case of hypokalemia with the i.v. insulin infusion.