Abstract
Common practice for the management of the new patient with insulin dependent diabetes (IDD) is hospitalization for institution of insulin therapy, diet and daily home management instruction. Standard protocols include basal insulin doses of 0.5 u/kg/24 hrs. plus supplemental doses of regular insulin every 4-6 hrs. according to urine and blood glucose concentrations. After several days an insulin dose is calculated. We have successfully utilized a new insulin dose regimen in 52 IDD pts. All patients received 1.0 u/kg/24 hrs. of s.c. NPH U-100 insulin which was delivered as 0.5 u/kg BID. Except in 16 pts. hospitalized 6 days or fewer (11 for DKA) all pts. began this regimen as outpatients. Extensive nutritional and daily home management instructions were provided on an outpatient basis. Urine testing for glucose and acetone was performed TID. When all urinary tests were negative for 3 days, the insulin dose was lowered to 0.5 u/kg/24 hrs. administered in 0.25 u/kg BID. Pts. were reassessed at 1 wk,1 mo., 3 mos. and every 3 mos. thereafter. Insulin dosage was maintained at 0.5 u/kg until an increase in glucose and acetone spillage suggested total insulin dependence. An estimated 250 hospital days and $98,000 were saved by using this regimen. A dosage decrease to 0.5 u/kg was experienced by 33 of 52 pts. Mean duration of 0.5 u/kg therapy was 7.2 mos.
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Duncan, J., Malone, J. A NOVEL APPROACH TO METABOLIC STABILIZATION IN THE NEWLY-DIAGNOSED DIABETIC. Pediatr Res 18 (Suppl 4), 229 (1984). https://doi.org/10.1203/00006450-198404001-00817
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DOI: https://doi.org/10.1203/00006450-198404001-00817