Treatment with low-dose IM versus SC + IV insulin

StudyPopulationInterventionOutcomesResultsCommentsDesignEL
Onur et al, 197951110 children with a history of diabetic ketoacidosis who had signs of ketoacidosis (pH < 7.35 or bicarbonate < 15 mEq/l)
Aged 4–15 years
USA
  1. IM 0.1 units/kg soluble insulin every 2 hours
  2. 0.1 units/kg soluble insulin, half give SC and half IV every 4 hours
Time to achieve serum glucose < 250 mg/dl
Immunoreactive glucagon concentration
Time to achieve serum glucose < 250 mg/dl was 5.3 ± 0.7 hours in the conventionally treated group and 7.1 ± 0.6 hours in the low- dose IM group. This is approximately 50% longer in the low-dose IM group to reach the same control, but this was not statistically significantly different
To achieve serum glucose < 250 mg/dl, total insulin required was 1.2 ± 0.2 units/kg in the conventionally treated group and 0.4 ± 0.1 units/kg in the low-dose IM group. This was statistically significantly different, p < 0.001. No significant difference in IV fluids given during this time
No difference in the immunoreactive glucagon concentration between the two groups when serum glucose was 250 mg/dl
Not randomisedControlled trial (alternate allocation)IIa

From: Evidence tables

Cover of Type 1 Diabetes
Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People.
NICE Clinical Guidelines, No. 15.2.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2004 Sep.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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