Insulin is required to normalise blood glucose & suppress ketogenesis

A continuous low dose IV infusion should be used

  • 50 units of Actrapid┬« in 50ml of 0.9% saline (1unit/ml solution)
  • Commence at EITHER 0.05 or 0.1 units/kg/hour
  • There is no evidence that one dose is superior to the other. 0.05 units/kg/hour should be sufficient in most cases. 0.1 units/kg/hour may be required in severe cases.

Do NOT add insulin directly to the fluid bags and do NOT give an insulin bolus

There is evidence that insulin given within the first hour of treatment increases the risk of cerebral oedema[35, 43-44]

Therefore, do NOT start insulin until intravenous fluids have been running for at least an hour[35]

  • Long acting insulin (i.e. Lantus┬«)
    • For patients with previously known diagnosis of diabetes, long acting insulin may be given subcutaneously at the normal dose & time during DKA treatment
    • For patients with first presentation of diabetes consider starting long acting insulin alongside DKA treatment
    • Check local policy for further information
  • Patients who use an insulin pump
    • The device should be turned off when starting DKA treatment
Fig.14: A continuous Insulin infusion should be maintained during acute treatment