Advanced Practice: Subcutaneous insulin for DKA!

DKA criteria:

  • Blood glucose > 250 mg/dl
  • HCO3 < 15 mEq/L
  • pH < 7.3
  • AG>12 mEq/L


Insulin Treatment

  • Traditionally all DKA is treated with a continuous infusion of regular insulin
  • This is labor intensive and typically requires an intensive care unit bed
  • Often mild DKA only requires a few hours of therapy with insulin infusions before transition to subcutaneous (SQ) insulin

SQ insulin

  • Small randomized trials have demonstrated similar times to resolution of DKA, similar total doses of insulin, and possible reduction in cost of therapy without any increased adverse outcomes
  • These have been limited to mild DKA in patients without serious comorbidites (i.e. sepsis, surgical pathology, shock)
  • See the below infographic for comparison of traditional vs subcutaneous dosing regimens


Vincent M and Nobecourt E. Treatment of diabetic ketoacidosis with subcutaneous insulin lispro: A review of the current evidence from clinical trials.  Diabetes and Metabolism 2013; 39:299-305.