Bağ Özlem, Tunç Selma, Nalbantoğlu Özlem, Ecevit Çiğdem, Öztürk Aysel, Özkan Behzat, Demir Korcan
Dr. Behçet Uz Children's Hospital, Clinic of Pediatrics, İzmir, Turkey, Phone: +90 232 464 6167 E-mail:
J Clin Res Pediatr Endocrinol. 2017 Jun 1;9(2):132-137. doi: 10.4274/jcrpe.3925. Epub 2016 Dec 30.
To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA).
Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed.
Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively).
After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.
评估糖尿病酮症酸中毒（DKA）缓解后皮下注射正规胰岛素治疗的最初48小时内初始胰岛素剂量对血糖控制的影响。
回顾过去3年住院的DKA患者记录[n = 76，中位年龄 = 10.0（6.0 - 12.0）岁，男/女：44/32]。根据皮下胰岛素起始剂量分布将患者分为两组。第1组（n = 28）接受的中位剂量为1.45 U/kg/天（1.41 - 1.5），第2组（n = 48）接受的中位剂量为0.96 U/kg/天（0.89 - 1）。分析临床和实验室数据。
治疗的最初48小时内，第1组的血糖中位数、最低值和最高值均显著低于第2组[213（171 - 242）对255（222 - 316），p = <0.001；102（85 - 151）对129（105 - 199），p = 0.004；335（290 - 365）对375（341 - 438），p = 0.001]。发生低血糖（<70 mg/dL）的患者数量相似[第1组，5例（17.9%）对第2组，4例（8.3%），p = 0.276]，且均无严重低血糖。与第2组相比，第1组血糖水平在目标范围内（100 - 200 mg/dL）的比例更高（37.5%对12.5%）且血糖结果>200 mg/dL的数量更低（50%对81.3%）（分别为p = 0.001和p < 0.001）。
DKA缓解后，较高的初始剂量1.4 - 1.5 U/kg/天正规胰岛素与儿童和青少年更好的血糖控制相关，且低血糖风险未增加。
