ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes

Sodium‐glucose co‐transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol

“…The STOP DKA Protocol recommends a tiered approach for supplemental insulin for those with symptoms of ketosis/DKA (Figure B). Extra bolus insulin every 2 to 4 h based on blood ketones and glucose can be calculated based on total daily insulin dose or by adjusting usual correction boluses . Extra carbohydrate should be ingested when extra bolus insulin is administered, especially when blood glucose is ≤14 mmol/L (Figure B).…”

“…Specifically, these previously published protocols do not provide detailed recommendations on exactly how much extra bolus insulin and carbohydrate should be administered in response to specific levels of blood glucose and ketones as part of a DKA risk mitigation strategy, 37,38 despite the availability of traditional sick-day protocols for type 1 diabetes that provide such information. [19][20][21] To try and bridge this care gap, we have developed the "STOP DKA Protocol" that includes a series of succinct directions with evidence-based recommendations and easy-to-follow directions. We submit that the safe use of SGLT inhibitors in type 1 diabetes begins with ensuring that only individuals with a key set of personal and clinical characteristics are prescribed these anti-hyperglycaemic agents ( Figure 3).…”

“…The STOP DKA Protocol has many recommendations that align with those in previously published DKA risk mitigation documents. [19][20][21]25,[32][33][34]37,38 One of the unique features of the STOP DKA Protocol is that it emphasizes a stepwise approach that takes its cue from the patient's glycaemia and ketone status. Notably, the blood ketone categories for assessing ketosis in the STOP DKA Protocol have been adapted from those typically used in sick-day protocols for type 1 diabetes ( Figure 6B).…”

Review of Leipzig protocol for intravenous insulin infusion in pediatric patients with type 1 diabetes during intercurrent illness and surgery

“…Therefore, one might criticize that BG target range of 4 to 8 mmol/L, selected in the study presented here, was too tight. The current guideline of ISPAD, in contrast, recommend to keep BG values between 4 and 10 mmol/L and 5 and 10 mmol/L during intercurrent illness or surgery in pediatric patients, respectively …”

“…Typical problems are distinct blood glucose (BG) fluctuation, hyperglycemia, and diabetic ketoacidosis because of increased insulin requirements, for example, during infections with fever. In gastroenteritis along with diarrhea and vomiting, as well as loss of appetite and therefore, a decreased food intake, patients could experience more hypoglycemia . Owing to these acute complications, comorbidity and mortality are increased in patients with T1D during intercurrent illness or surgery .…”