Hold insulin if K+ < 3.3 and give K+ replacement first to get it b/n 3.3 and 5.3 otherwise insulin will drive K into cells and worsen hypokalemia. This can trigger arrhythmias and muscle weakness. Regular insulin 0.1 units/kg/hr IV bolus & then within 5 minutes start 0.1 units/kg/hr IV drip.
If glucose doesn’t fall by at least by 50 to 70 mg/dL from the initial value in the first hr, will check the IV access to be sure that the insulin is being delivered and make sure that no IV line filters that may bind insulin have been inserted into the line. After these possibilities are eliminated, we will double the insulin infusion rate every hr until a steady decline in serum glucose of this magnitude is achieved.
When serum glucose reaches 200 mg/dL, will reduce regular insulin infusion to 0.02-0.05 U/Kg/hr IV, or give rapid-acting insulin at 0.1 U/kg SC every two hours.
Will Keep serum glucose between 150 and 200 mg/dL until resolution of DKA.
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Lack of insulin is the main cause of DKA. Insulin deficiency is the main precipitating factor. So these patients need insulin.
Related Article: Diabetic Ketoacidosis (DKA) Treatment