DKA in baby< 2y

Based on Section 6.6 of the ISPAD 2022 Guidelines (Glaser et al., 2022), the recommended type of insulin after IV insulin for a child (including infants under 2 years old) with DKA is:

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Correct Transition to Subcutaneous Insulin:

“When ketoacidosis has resolved, oral intake is tolerated, and the change to SC insulin is planned, a dose of basal (long-acting) insulin should be administered in addition to rapid- or short-acting insulin.”

Key points:

• The first SC insulin injection should be:
  • 15–30 minutes before stopping IV insulin if using rapid-acting insulin
  • Longer overlap if starting basal insulin
• Basal insulin can be started while the IV insulin is still running to allow overlap and a smoother transition.

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In Egypt – Brand Names Suitable for Infants <2 years:

Basal (long-acting)

Lantus® (insulin glargine)

Levemir® (insulin detemir)

Once daily or split BID in infants

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Rapid-acting

NovoRapid® (insulin aspart)

Humalog® (insulin lispro)

Before feeds or meals

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In short: the use of basal-bolus regimens (with long-acting + rapid-acting insulin) is appropriate and recommended even in infants under 2 years, as long as:

• Feeding is established
• Close glucose monitoring is available
• Caregivers are educated

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Reference: ISPAD Clinical Practice Consensus Guidelines 2022 – Section 6.6: Introduction of oral fluids and transition to SC insulin injections (Glaser N, et al. Pediatric Diabetes. 2022; 23: 835–856.) https://www.ispad.org/resource/chapter-11-diabetic-ketoacidosis.html