II. Indications
III. Protocol: Adults
- See Diabetic Ketoacidosis Management in Adults
-
General
- Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
- 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: 0.2 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. Protocol: Children
- See Diabetic Ketoacidosis Management in Children
- Precautions
- SQ Insulin for DKA Management is less established in children
-
General
- Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
- Coadminister fluids as per Diabetic Ketoacidosis
- Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
- Every 2 hour SQ Insulin Protocol
- Give 0.1 to 0.15 units/kg every 1-2 hours
- Decrease dosing as Hyperglycemia corrects (Blood Glucose <250 mg/dl)
V. Precautions
- Correct Hypokalemia prior to Insulin Dosing
- Fluid administration is central to DKA treatment
VI. Monitoring
- Blood Glucose every 30 minutes to 1 hour
VII. Advantage over Insulin Infusion
- May be monitored on regular medical ward (non-ICU)
- Reduced cost by 39% compared with infusion
VIII. Safety and efficacy
- As effective and safe as Insulin Infusion