II. Indications
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Diabetic Ketoacidosis in Adults
- Alternative to Insulin Infusion (Insulin Drip)
III. Protocol: Subcutaneous InsulinLispro
-
General
- Coadminister fluids as per Diabetic Ketoacidosis
- Discontinue hourly dosing when Glucose 150-200
- Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
- Hourly SQ Insulin Protocol
- Initial SQ bolus dose: 0.3 units/kg (other protocols start with 0.1 unit/kg)
- Next: 0.1 units/kg/hour SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
- Next: 0.05 units/kg/hour SQ until DKA resolves
- Every 2 hour SQ Insulin Protocol
- Initial SQ bolus dose: 0.3 units/kg
- Next: 0.3 units/kg every 2 hours SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
- Next: 0.1 units/kg every 2 hours SQ until DKA resolves
IV. Precautions
- Correct Hypokalemia prior to Insulin Dosing
- Fluid administration is central to DKA treatment
V. Monitoring
- Blood Glucose every 30 minutes to 1 hour
VI. Advantage over Insulin Infusion
- May be monitored on regular medical ward (non-ICU)
- Reduced cost by 39% compared with infusion
VII. Safety and efficacy
- As effective and safe as Insulin Infusion