From the Guidelines
For adult patients with Diabetic Ketoacidosis (DKA), the recommended insulin drip dosage is 0.1 unit kg–1 h–1, which is equivalent to 5–7 units/h in adults, as a continuous intravenous infusion of regular insulin. This dosage is supported by the study published in Diabetes Care in 2004 1, which suggests that an initial insulin bolus of 0.15 units/kg body weight should be followed by a continuous infusion of regular insulin at a dose of 0.1 unit kg–1 h–1.
Key Considerations
- The insulin infusion should be initiated after excluding hypokalemia (K < 3.3 mEq/l) 1.
- The initial insulin bolus is not recommended in pediatric patients, and the continuous insulin infusion should be started when the plasma glucose reaches 250 mg/dl in DKA or 300 mg/dl in HHS 1.
- The low dose of insulin usually decreases plasma glucose concentration at a rate of 50 –75 mg dl–1 h–1, and if plasma glucose does not fall by 50 mg/dl from the initial value in the 1st hour, the insulin infusion may be doubled every hour until a steady glucose decline between 50 and 75 mg/h is achieved 1.
Monitoring and Adjustments
- Blood glucose should be monitored hourly, and when it falls below 200-250 mg/dL, dextrose-containing fluids (D5W or D10W) should be added while continuing the insulin infusion to prevent hypoglycemia.
- Potassium levels must be closely monitored and replaced as needed, as insulin therapy drives potassium into cells.
- The insulin drip should continue until the patient's anion gap normalizes, indicating resolution of ketoacidosis.
- Once the patient is stable, can eat, and ketoacidosis has resolved, transition to subcutaneous insulin can begin.
From the Research
Insulin Drip Dosage in Adult Patients with Diabetic Ketoacidosis (DKA)
- The insulin drip dosage in adult patients with DKA is a crucial aspect of their treatment, with the aim of normalizing blood glucose levels and resolving ketoacidosis.
- According to the study by 2, the recommended insulin infusion rate is 0.1 units/kg/h, which can be de-escalated to 0.05 units/kg/h when the glucose concentration drops below 14 mmol/L.
- This recommendation is specific to adult patients, and the study emphasizes the importance of considering the patient's age and care team when determining the appropriate treatment protocol.
- Other studies, such as 3, 4, and 5, do not provide explicit recommendations for insulin drip dosage, but rather focus on the safety and efficacy of initial insulin bolus doses and the use of different treatment protocols.
- A review of existing studies on adult DKA management protocols, published in 6, highlights the lack of strong evidence for optimal insulin administration, including the use of fixed weight-based insulin infusions versus sliding scale insulin infusions.
Key Considerations
- The insulin drip dosage may need to be adjusted based on individual patient factors, such as glucose levels and renal function.
- The use of an initial insulin bolus dose is a topic of debate, with some studies suggesting that it may not provide significant benefits and may even increase the risk of complications, as reported in 3 and 4.
- The implementation of DKA management protocols, including insulin administration, requires careful consideration of the available evidence and consensus opinion, as highlighted in 6.