Early Glargine (Lantus) in DKA Management in Children With Type 1 Diabetes

Inclusion Criteria

• Age 6-17.9 years at time of enrollment.
• Known history of type 1 diabetes or presumed new-onset type 1 diabetes.
• Diagnosis of DKA (serum glucose or fingerstick glucose concentration ≥ 200 mg/dL.
• Venous pH ≤7.3 and/or serum bicarbonate concentration ≤15 mmol/L.
• Evidence of ketonemia or ketonuria).

Exclusion Criteria

• Participants who present in DKA with conditions that affect neurological function such as:
• suspected alcohol or drug use,
• severe head trauma,
• meningitis, etc., who would not be able to consent/assent for the study.
• Participants who present in DKA who are showing signs of altered mental status at time of enrollment.
• Other known complicating illness or poorly-controlled chronic illness that is known to affect blood glucose levels and/or electrolyte balance such as:
• chronic renal disease (requiring hemodialysis),
• chronic liver disease (with evidence of current hepatic dysfunction,
• coagulopathy, and/or chronic hepatitis), or
• severe chronic lung disease (requiring the use of oral steroids).
• Use of medications that are known to affect blood glucose levels such as:
• oral glucocorticoids,
• Metformin,
• SGLT2 inhibitors,
• GLP-1 receptor agonists,
• DPP-4 inhibitors,
• thiazolidinediones
• sulfonylureas, and
• vasopressors, etc.
• Participants who have begun DKA treatment prior to being approached for enrollment and have received more than 6 hours of IV insulin therapy.
• Participants who are known to be pregnant.
• Participants who have a known diagnosis of type 2 diabetes.
• Participants for whom the treating physicians feel a specific insulin regimen is necessary such that patient safety or well-being could be compromised by enrollment into the study.