What is the target blood glucose level in Diabetic Ketoacidosis (DKA)?

From the Guidelines

The target blood sugar in diabetic ketoacidosis (DKA) management is 150-250 mg/dL (8.3-13.9 mmol/L). Treatment typically begins with intravenous insulin at 0.1 units/kg/hour after initial fluid resuscitation, as recommended by the study published in Diabetes Care 1. Blood glucose should be monitored hourly, with the goal of decreasing glucose by approximately 50-75 mg/dL per hour.

Key Considerations

• Once blood glucose reaches 200-250 mg/dL, dextrose (usually D5W or D10W) should be added to the IV fluids while continuing insulin therapy to prevent hypoglycemia, as suggested by the evidence 1.
• This approach allows for continued insulin administration to suppress ketogenesis while maintaining safe glucose levels.
• It's essential not to correct hyperglycemia too rapidly, as this can increase the risk of cerebral edema, particularly in children and young adults, as highlighted in the study 1.
• The insulin infusion should be continued until the anion gap normalizes and ketoacidosis resolves, even if blood glucose reaches target levels earlier, to prevent recurrence of DKA despite normalized blood glucose levels, as emphasized by the evidence 1.

Monitoring and Adjustments

• Blood glucose should be monitored hourly to adjust the insulin infusion rate and prevent hypoglycemia.
• The rate of insulin administration or the concentration of dextrose may need to be adjusted to maintain the target glucose values until acidosis in DKA or mental obtundation and hyperosmolarity in HHS are resolved, as recommended by the study 1.
• Ketonemia typically takes longer to clear than hyperglycemia, and assessments of urinary or serum ketone levels by the nitroprusside method should not be used as an indicator of response to therapy, as noted in the evidence 1.

From the Research

Target Blood Sugar in DKA

• The target blood sugar in Diabetic Ketoacidosis (DKA) is not explicitly stated in the provided studies, but the treatment protocols mentioned involve monitoring serum glucose levels and adjusting insulin therapy accordingly 2, 3, 4, 5, 6.
• According to the study published in 2024, DKA is diagnosed by the triad of hyperglycemia (blood glucose greater than 250 mg/dL), metabolic acidosis, and elevated serum or urine ketones, although hyperglycemia has been de-emphasized in recent guidelines due to the increasing incidence of euglycemic DKA 6.
• The study from 1987 mentions that serum glucose is measured every two to three hours during the first six to nine hours of treatment 2.
• Another study from 1982 compares two protocols for treating severe DKA in children and notes that the fall of glucose concentration was similar in both groups, but does not specify a target blood sugar level 3.
• The 1983 study discusses the pathogenesis, prevention, and therapy of DKA, but does not provide a specific target blood sugar level, instead emphasizing the importance of low-dose insulin therapy, rehydration, and potassium replacement 4.
• The 1976 study discusses the treatment of ketoacidosis, including insulin therapy titrated against the change in blood glucose concentration, but does not specify a target blood sugar level 5.