III. Protocol: Adults

  1. See Diabetic Ketoacidosis Management in Adults
  2. General
    1. Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
    2. Coadminister fluids as per Diabetic Ketoacidosis
    3. Discontinue hourly dosing when Glucose 150-200
    4. Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
  3. Hourly SQ Insulin Protocol
    1. Initial SQ bolus dose: 0.3 units/kg (other protocols start with 0.1 unit/kg)
    2. Next: 0.1 units/kg/hour SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
    3. Next: 0.05 units/kg/hour SQ until DKA resolves
  4. Every 2 hour SQ Insulin Protocol
    1. Initial SQ bolus dose: 0.3 units/kg
    2. Next: 0.2 units/kg every 2 hours SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
    3. Next: 0.1 units/kg every 2 hours SQ until DKA resolves

IV. Protocol: Children

  1. See Diabetic Ketoacidosis Management in Children
  2. Precautions
    1. SQ Insulin for DKA Management is less established in children
  3. General
    1. Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
    2. Coadminister fluids as per Diabetic Ketoacidosis
    3. Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
  4. Every 2 hour SQ Insulin Protocol
    1. Give 0.1 to 0.15 units/kg every 1-2 hours
    2. Decrease dosing as Hyperglycemia corrects (Blood Glucose <250 mg/dl)

V. Precautions

  1. Correct Hypokalemia prior to Insulin Dosing
  2. Fluid administration is central to DKA treatment

VI. Monitoring

  1. Blood Glucose every 30 minutes to 1 hour

VII. Advantage over Insulin Infusion

  1. May be monitored on regular medical ward (non-ICU)
  2. Reduced cost by 39% compared with infusion

VIII. Safety and efficacy

  1. As effective and safe as Insulin Infusion

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Ontology: Insulin (C0021641)

Definition (NCI) A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Definition (NCI) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism.
Definition (CSP) protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose and is also an important regulator of protein and lipid metabolism; insulin is used as a drug to control insulin-dependent diabetes mellitus.
Definition (MSH) A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D007328
SnomedCT 325014006, 67866001, 39487003, 412222002
LNC LP70329-5, LP16325-0, LP14676-8, LP32542-0, MTHU002108, MTHU019392, LA15805-7
English Insulin, insulin, Regular Insulin, Soluble insulin, Insulin Regular, insulin preparations, insulin preparations (medication), insulin regular, Insulin [Chemical/Ingredient], insulin products, insulin preparation, insulin product, regular insulin, insulins, Insulin, Soluble, Soluble Insulin, Soluble insulin (substance), Insulin regular, Insulin, Regular, Insulin product, Insulin (substance), Insulin preparation, Insulin product (product), Regular insulin product, Unmodified insulin product, Insulin preparation, NOS, Regular insulin preparation, Unmodified insulin preparation, Insulin preparation (substance), Regular insulin (substance), Regular insulin, INSULIN
Swedish Insulin
Finnish Insuliini
French Insuline ordinaire, Insuline soluble, Insuline
Russian INSULIN, ИНСУЛИН
Spanish producto con insulina (producto), preparado insulínico, insulina (producto), producto con insulina, insulina (sustancia), insulina, preparado de insulina (producto), preparado de insulina (sustancia), preparado de insulina cristalina de cinc, preparado de insulina cristalina de zinc, preparado de insulina no modificada, preparado de insulina, insulina regular (sustancia), insulina regular, Insulina
Italian Insulina regolare, Insulina
Croatian INZULIN
Polish Insulina
Japanese インスリン, インスリン亜鉛水性懸濁液, インシュリン
Czech inzulin, insulin
Norwegian Insulin, Oppløselig insulin
German Insulin
Portuguese Insulina