Impact of early administration of long-acting insulin on ketosis rebound in diabetic ketoacidosis

Background

Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic disorder that can occur with the onset or during follow-up of type 1 diabetes (T1D). Once DKA has been resolved, discontinuing the intravenous insulin infusion may lead to a rebound of hyperglycemia. Therefore, this study aimed to demonstrate that early administration by an injection of long-acting insulin avoids a ketosis rebound after stopping intravenous insulin.

Methods

A retrospective study was conducted in the Femme-Mère-Enfant Hospital. We included patients aged 0 and 18 years, admitted to the intensive care unit and then to pediatric diabetology for DKA between January 2022 and April 2023. We separated patients into two groups depending on the protocol received. For the "old protocol" group, intravenous insulin was stopped when the acidosis was resolved, and before the patient was transferred, subcutaneous insulin injections were given in diabetology. For the "new protocol" group, subcutaneous injections of long-acting and rapid-acting insulin were administered before discontinuing the intravenous infusion in the intensive care unit before transfer.

Results

A total of 58 children were included. 46 patients were managed for inaugural DKA and 12 for DKA decompensating of known T1D. 41 patients received the old protocol, and 17 the new protocol. The incidence of ketosis rebound was lower in the "new protocol" group (41.2 % vs. 75.6 %; p 0.027). There is a significant association between the new protocol and reduced risk of ketosis rebound (OR 0.23, p 0.015). Multivariate analysis adjusted for potential confounding factors doesn't modify these results (OR 0.25, p 0.045).

Conclusion

Our study is the first pediatric study suggesting that earlier injection of long-acting insulin after resolution of DKA in children reduces the risk of ketosis rebound.