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.