Advanced Practice: Subcutaneous insulin for DKA!
- Blood glucose > 250 mg/dl
- HCO3 < 15 mEq/L
- pH < 7.3
- AG>12 mEq/L
- 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
- 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.