Martin M M, Martin A A
J Pediatr. 1976 Oct;89(4):560-4. doi: 10.1016/s0022-3476(76)80386-1.
Twelve diabetic children--eight in ketoacidosis, three with insulin refractory hyperglycemia, and one postoperative patient--were treated with continuous, low-dose, intravenous infusion of insulin. The eight ketoacidotic children with a mean serum glucose concentration on admission of 631 mg/dl and bicarbonate value of 6.8 mM/1 were given regular insulin, 0.1 U/kg, slowly by bolus injection followed by a sustaining infusion of 0.1 U/kg/hour. Plasma glucose concentration fell at a mean rate of 82 mg/dl/hour. Euglycemia with concomitant improvement in the metabolic disorder was achieved with a mean dose of insulin, 0.68 U/kg, given over four to 10 hours. Mean plasma insulin in those children who had not previously received insulin was 55 muU/ml, well within the normal physiologic range. Growth hormone and serum triglyceride levels, low initially, rose with insulin therapy before returning to control values. Continuous low-dose insulin infusion is simple, safe, and effective, avoids confusion and empiricism, and appears to be the method of choice for the treatment of diabetic ketoacidosis or insulin resistance.
