TREATMENT OF DIABETIC COMA IN CHILDREN

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Abstract
A short review is given on current aspects of the low-dose insulin therapy of diabetic ketoacidosis, and briefly on the other aspects of the treatment. Frequent intramuscular administration of low doses of regular insulin leads to plasma insulin concentrations, sufficient for maximal insulin biologic activity. The intravenous and subcutaneous routes of insulin administration are suitable as well in the low-dose insulin therapy. The author described results from a retrospective study comparing the efficacy of large and small insulin doses in the treatment of diabetic precoma and coma in children (1). The i.m. administration of insulin, 0.5 U/kg initially, followed by 0.25 U/kg at intervals of 1/2-3 hours led to as rapid disappearance of the signs and symptoms of ketoacidosis as with previously used larger insulin doses. The tendency to hypoglycemia and hypokalemia was milder with the smaller insulin dose. With such a modified low-dose insulin therapy it is essential to initiate i.v. glucose administration rather early. The responsiveness to insulin may vary from one child to another, and infections may increase the need for insulin. Therefore, careful individual monitoring of the treatment is important even when using the low-dose insulin therapy.