Subcutaneous insulin treatment for mild pediatric diabetic ketoacidosis: an evaluation of treatment duration and length of stay

OBJECTIVES: Although intravenous (IV) insulin remains the standard treatment for diabetic ketoacidosis (DKA), subcutaneous (SC) insulin has been suggested as an alternative for uncomplicated DKA. We compared treatment duration, hospital length of stay (LOS) and adverse events in children with mild DKA treated with a SC insulin protocol to those of children treated with an IV insulin protocol. METHODS: We reviewed medical records of children with mild DKA admitted to a children's hospital before and after introduction of a SC insulin protocol. Children treated with the SC protocol received daily basal insulin along with rapid-acting insulin every 4 h. We compared outcomes for children treated with SC insulin to those of children treated with IV insulin. RESULTS: Twenty two children were treated with SC insulin and 29 with IV insulin. In the SC group vs. the IV group, mean protocol duration (17.1 ± 8.6 vs. 13.5 ± 4.6 h) and LOS (34.9 ± 16.7 vs. 37.8 ± 23.6 h) were not significantly different (p=0.07 and p=0.63, respectively). There were no significant differences in adverse events frequency between groups. No child treated with SC insulin required a change to IV insulin treatment. CONCLUSIONS: Treatment of children with uncomplicated mild DKA with SC insulin is safe and effective without prolonging LOS.