Abstract

Background: The primary objective was to compare time taken until resolution of
acidosis in standard dose insulin infusion group and low dose insulin infusion group.
The secondary objectives were to compare the time taken until decline in blood glucose
till 250 mg/dl in both the groups, to compare the proportion of children developing
Hypoglycemia in both the groups, to compare the proportion of children developing
Hypokalemia in both the groups, to compare the episodes of treatment failures in both
the groups.
Materials and Methods: This study was conducted from March 2017 to August 2018,
atMamatha Medical College,Khammam with aim to compare efficacy and safety of low
dose insulin infusion against standard dose insulin infusion in children with diabetic
ketoacidosis. All consecutive children 12 years of age or younger, admitted with
diagnosis of Diabetic Ketoacidosis were enrolled for the study. Children who present
with symptomatic cerebral edema were excluded from the study. Cases were enrolled
after valid consent obtained from the parents. Among 34 eligible cases, 30 were
randomized equally into two groups and 4 cases were excluded due to symptomatic
cerebral edema. Total 30 cases 15 in each group completed the study and were available
for data analysis.
Results: In our study mean age in standard dose insulin infusion group was 8.30+/- 2.57
years and in low dose insulin infusion group was 6.83+/- 2.67 years. After fast breathing
(93.3%), vomiting (90%), and pain abdomen (76.6%), polyurea (76.6%), polydypsia
(73.7%), fever (56.7%), altered sensorium (53.3%), were the predominant presenting
complaints of DKA. Signs of dehydration (100%) were the most common presenting
signs of DKA followed by acidotic breathing (93%) and tachycardia (86%). In our
study, most common precipitating causes of DKA, infection (46.7%), followed by
unknown cause (26.7%), and dose omitted (23.3%), and insufficient dose (3.3%).
Family history was present in 16.7% patients. Malnutrition was present in 40% cases of
DKA.
Conclusion: To conclude, the time taken to resolution of acidosis is similar in standard
dose insulin infusion group and low dose insulin infusion group and time taken to
decline blood glucose till 250 mg/dl or less is similar in both the groups. Incidence of
hypoglycemia and hypokalemia comparatively less in low dose insulin infusion group.
Treatment failure was not found in both the groups.