August 23, 2005

Fast-acting insulin OK for kids in diabetic crisis

NEW YORK (Reuters Health) - When children with diabetes
don't get enough insulin, impurities can build up rapidly in
the body and cause a medical emergency. However, diabetic
ketoacidosis, as the condition is called, can be treated
effectively and relatively simply with a fast-acting insulin
analog injected subcutaneously, a new study shows.

The current standard of treatment for diabetic
ketoacidosis, or DKA, is continuous intravenous administration
of insulin, which may require admission to an intensive care
unit, Dr. Durval Damiani of Sao Paulo University Medical School
in Brazil and colleagues note in the medical journal Diabetes

The team conducted a study to compare the fast-acting
insulin analog lispro to continuous intravenous regular insulin
in pediatric patients with DKA.

Sixty children with DKA were randomly assigned to treatment
with continuous regular insulin or lispro given every 2 hours,
which was reduced to every 4 hours once blood sugar levels
began to fall. All the children were given IV fluid

Blood glucose levels fell below danger levels within 6
hours after therapy began in both groups, the researchers
report. However, acidosis and ketosis resolved somewhat more
quickly in the continuous insulin group than in the lispro

This was likely due to a "less than optimum" administration
schedule in the lispro group, Damiani and colleagues suggest,
adding that smaller doses given at shorter time intervals may
have been more effective.

Nonetheless, the lispro approach promises simplicity and
cost savings. As the investigators say: "Protocols of DKA
treatment with subcutaneous rapid-acting analogs represent a
technical simplification and may lower the mean cost for
hospitalization as the patient would not need either insulin
pumps or a second intravenous line."

SOURCE: Diabetes Care, August 2005.