Introduction: The initial insulin doses for children with newly diagnosed type 1 diabetes mellitus (T1DM) are dependent on the degree of ketosis at presentation, reflecting the presence of insulin resistance. The concept of metabolic memory has heightened the importance of improving glycaemic control following diagnosis.
Aim: To determine whether current local prescribing guidelines accurately predict insulin requirement at initiation of treatment following a new diagnosis of T1DM.
Methods: The paper and electronic medical records of all children with newly diagnosed T1DM presenting to a tertiary paediatric hospital over a 6-month period were reviewed to obtain data on insulin dosing at presentation, at hospital discharge and 6 weeks after diagnosis.
Results: 23 patients (11 male, 11 in diabetic ketoacidosis (DKA)) presented over a 6-month period. Results were analysed in three cohorts: patients in DKA (n=11); those not in DKA with ketones ≥ 1.5 mmol/l (n=5); patients not in DKA with ketones <1.5 mmol/l (n=7). SUBCUTANEOUS insulin doses tended to be higher in the DKA and elevated ketones group prior to discharge (Table 1).
|Patient cohort||IV insulin during last 24 hours of treatment||Initiation of SC treatment||Hospital discharge||6 week clinic follow-up|
|DKA||0.98 (0.482.07)||0.70 (0.610.80)||0.97 (0.621.45)||0.60 (0.41.1)|
|Non-DKA Ketones ≧ 1.5||N/A||0.70 ()||0.87 (0.71.4)||0.50 (0.310.97)|
|Non-DKA Ketones < 1.5||N/A||0.50 (0.450.83)||0.56 (0.461.1)||0.57 (0.180.85)|
Conclusion: Children with significant ketosis (including DKA) at presentation appear to require more SUBCUTANEOUS insulin at initiation of treatment than is currently given. We have revised our care pathways to provide between 0.5 and 1 unit/kg per day depending on degree of ketosis and acidosis.
12 - 14 Nov 2014
British Society for Paediatric Endocrinology and Diabetes