Endocrine Abstracts

JOINT3069

Objectives: To evaluate the effects and safety of subcutaneous injections of rapid-acting aspart insulin for treatment of uncomplicated mild and moderate DKA in children and also to determine the times to resolution of DKA.

Study Design: Prospective, single-arm, uncontrolled study of children and adolescents with DKA in 2022.

Setting: Hamadan University teaching hospital.

Data collected: Age, sex, clinical/laboratory parameters including severity of dehydration and diabetic-ketoacidosis, time to recover from DKA, hospitalization’s duration, complications, blood glucose, sodium, potassium, creatinine, urine ketones. Patients were admitted to the pediatric endocrinology unit outside the PICU where appropriate nursing care and access to laboratory test results were available. Based on the degree of dehydration, fluid deficit was replaced by sodium chloride 0. 45%. Insulin aspart 0. 15 units/kg subcutaneous was injected every 2 hours in the hospital outside ICU. Blood glucose was measured hourly and blood gases every 2 hours. Ketoacidosis was considered resolved when the patient did not have nausea/vomiting, was conscious, and could eat, and blood glucose was <250 mg/dL, pH was >7. 30, and/or HCO3 was >15 mmol/l.

Results: A total of 25 DKA patients (mean age 11. 06±3. 89, range 4-17 years, 60% female) were included in the study. Sixteen of the participants (64%) had type 1 diabetes. Overall, 13 (52%) cases had mild ketoacidosis (average pH=7. 25), and 12 (48%) cases had moderate ketoacidosis (average pH=7. 15). The average time to resolution of ketoacidosis was 11. 24 hours. Mean duration of hospitalization was 2. 3 days. All but one patient met DKA recovery criteria without complications. Mild cases compared to moderate cases of DKA had a shorter duration to resolution of DKA (P = 0. 04(. There were no electrolyte disturbances, hypoglycemic events, readmissions and deaths or other adverse events.

Conclusion: Subcutaneous rapid-acting insulin aspart is an effective, safe, and convenient alternative to intravenous infusion of regular insulin for children and adolescent with uncomplicated mild and moderate DKA.

Keywords: : Aspart; diabetic ketoacidosis; rapid-acting insulin; subcutaneous insulin.