From the Guidelines
Patients with diabetic ketoacidosis (DKA) on Glucomander can be fed, either orally or via tube feeding, without waiting for a complete transition to subcutaneous insulin, as long as blood glucose levels are closely monitored and the insulin infusion rate is adjusted accordingly. This approach is supported by the latest standards of care in diabetes, which emphasize the importance of personalized and interprofessional management of individuals with DKA 1. When initiating feeding, it's crucial to start with small, frequent meals or a low rate of enteral nutrition to avoid overwhelming the patient's glucose control. The Glucomander algorithm can help adjust the insulin rate based on blood glucose monitoring, ensuring that the patient receives adequate insulin coverage for the carbohydrate intake.
Key considerations for feeding patients with DKA on Glucomander include:
- Close monitoring of blood glucose levels to adjust the insulin infusion rate as needed
- Initiating feeding with small, frequent meals or a low rate of enteral nutrition
- Ensuring adequate fluid replacement and treatment of any concurrent infections
- Providing appropriate follow-up to avoid recurrent DKA. It's also important to note that the administration of basal insulin 2–4 hours before stopping the intravenous insulin can help prevent recurrence of ketoacidosis and rebound hyperglycemia, as highlighted in the recent diabetes care standards 1. By carefully managing glucose levels and adjusting the insulin infusion rate, patients with DKA on Glucomander can receive necessary nutrition without delaying their transition to subcutaneous insulin.
From the Research
Feeding People with DKA
- Feeding people with Diabetic Ketoacidosis (DKA) can be done through oral nutrition or tube feeding, and the timing of initiation is crucial [ 2 , 3 ].
Oral Nutrition
- A retrospective observational cohort study found that early oral nutrition (within 24 hours of admission) was associated with decreased hospital and MICU lengths of stay without increasing the rate of DKA complications [ 2 ].
- Another study found that oral nutrition until DKA resolves allows patients to recover more quickly and have a shorter hospital stay [ 3 ].
Subcutaneous Insulin
- Subcutaneous insulin lispro injections every 1-2 hours may be an alternative to continuous intravenous infusions of regular insulin for non-severe DKA patients [ 4 ].
- A protocol for an updated systematic review and meta-analysis of randomized trials is currently underway to examine the safety and benefits of subcutaneous fast-acting insulin analogues with or without subcutaneous long-acting insulin versus intravenous regular insulin infusion in DKA [ 5 ].
Management of DKA
- Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event [ 6 ].