Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting
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Bereket F. Yismaw
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Tigist W. Leulseged
Abstract
Objectives
The standard recommendation of insulin therapy for patients with DKA is the administration of slow continuous intravenous (IV) regular insulin. Currently subcutaneous insulin is being recommended as an alternative treatment of DKA in mild and moderate cases in resource-limited settings. The purpose of this study was to assess the effectiveness and safety of six-hourly subcutaneous regular insulin use for the treatment of DKA among children with type one diabetes mellitus.
Methods
A retrospective cohort study was conducted among 224 DKA episodes which occurred in 161 children who were treated at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from November 2015 to November 2020.
Results
Majority (68.8%) of the episodes occurred in newly diagnosed cases. The median time for urinary ketones clearance was 24 h. DKA severity was found to be the only significant predictor of time to DKA resolution. Only 13 (5.8%) were treated at the pediatric intensive care unit (PICU), and 27 (12.1%) developed complications during management. No death or neurological complications observed.
Conclusions
The six-hourly subcutaneous regular insulin use was found to be safe and effective alternative to slow IV insulin infusion for the treatment of DKA in a non PICU setting. As it resulted in minimum morbidity and no mortality, we recommend its use in the treatment of DKA irrespective of its severity. It can also decrease the health care cost and patients’ inconvenience.
Acknowledgments
The authors would like to thank St. Paul’s Hospital Millennium Medical College for facilitating the research work by granting IRB approval and availing the data needed for the research. We also would like to extend our great appreciation to the data collectors for their commitment and timely work.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: The SPHMMC institutional review board approved the study protocol.
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© 2021 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Obesity after the Covid-19 pandemic and beyond
- Review Article
- Clinical profile and management challenges of disorders of sex development in Africa: a systematic review
- Original Articles
- Development and validation of a mobile application for point of care evaluation of growth failure
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- Accelerated pubertal onset in short children with delayed bone age
- Screening for hypophosphatasia: does biochemistry lead the way?
- Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting
- NPR2 gene variants in familial short stature: a single-center study
- The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience
- Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients
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- Non-inferiority of liquid thyroxine in comparison to tablets formulation in the treatment of children with congenital hypothyroidism
- Short Communication
- Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: preliminary results of a tertiary center study
- Case Reports
- Gordon syndrome caused by a CUL3 mutation in a patient with short stature in Korea: a case report
- Nitisinone treatment during two pregnancies and breastfeeding in a woman with tyrosinemia type 1 – a case report
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Artikel in diesem Heft
- Frontmatter
- Editorial
- Obesity after the Covid-19 pandemic and beyond
- Review Article
- Clinical profile and management challenges of disorders of sex development in Africa: a systematic review
- Original Articles
- Development and validation of a mobile application for point of care evaluation of growth failure
- Children-Dietary Inflammatory Index (C-DII), cardiometabolic risk, and inflammation in adolescents: a cross-sectional study
- Accelerated pubertal onset in short children with delayed bone age
- Screening for hypophosphatasia: does biochemistry lead the way?
- Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting
- NPR2 gene variants in familial short stature: a single-center study
- The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience
- Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients
- Development and assessment of a low-health-literacy, pictographic adrenal insufficiency action plan
- Effect of insulin resistance on lung function in asthmatic children
- A major health problem facing immigrant children: nutritional rickets
- Clinical profile, etiology, and diagnostic challenges of primary adrenal insufficiency in Sudanese children: 14-years’ experience from a resource limited setting
- Non-inferiority of liquid thyroxine in comparison to tablets formulation in the treatment of children with congenital hypothyroidism
- Short Communication
- Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: preliminary results of a tertiary center study
- Case Reports
- Gordon syndrome caused by a CUL3 mutation in a patient with short stature in Korea: a case report
- Nitisinone treatment during two pregnancies and breastfeeding in a woman with tyrosinemia type 1 – a case report
- Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome
- First successful concomitant therapy of immune tolerance induction therapy and desensitization in a CRIM-negative infantile Pompe patient
