From the Guidelines
The treatment for mild euglycemic diabetic ketoacidosis (DKA) should involve subcutaneous rapid-acting insulin analogs, as it may be safer and more cost-effective than treatment with intravenous insulin, according to the latest standards of care in diabetes-2025 1. When managing mild euglycemic DKA, it is essential to provide adequate fluid replacement, frequent point-of-care blood glucose monitoring, treatment of any concurrent infections, and appropriate follow-up to avoid recurrent DKA.
- Key aspects of treatment include:
- Administering subcutaneous rapid-acting insulin analogs, which have been shown to have no significant difference in outcomes compared to intravenous human regular insulin when combined with aggressive fluid management 1.
- Providing adequate fluid replacement, as this is crucial in managing DKA.
- Monitoring blood glucose and electrolytes closely, particularly potassium, and replacing as needed.
- Avoiding the use of bicarbonate, as several studies have shown that it makes no difference in the resolution of acidosis or time to discharge 1.
- Discontinuing SGLT2 inhibitors, if the patient is on them, as they are a common cause of euglycemic DKA. The goal of treatment is to resolve ketoacidosis, which can be achieved by administering basal insulin 2–4 h before stopping intravenous insulin, if used, to prevent recurrence of ketoacidosis and rebound hyperglycemia 1.
From the Research
Treatment for Mild Euglycemic DKA
- The treatment for mild euglycemic DKA includes rapid correction of dehydration, correction of electrolyte abnormalities, and use of insulin drip until the anion gap and bicarbonate levels normalize 2.
- A treatment algorithm is proposed to guide clinicians in managing euglycemic DKA, which includes monitoring anion gap and ketones to guide insulin and fluid management, and a slower transition to subcutaneous insulin to prevent relapse 3.
- The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin, and in euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis 4.
- Management of euglycemic DKA includes resuscitation with intravenous fluids, insulin, and glucose, with treatment of the underlying etiology, and laboratory assessment includes venous blood gas for serum pH, bicarbonate, and ketones 5.
- Increased glucose administration using higher percentages of dextrose (10 or 20%) may be required to facilitate the concomitant administration of the relatively large amounts of insulin that are needed to correct the severe acidosis in these patients 2.
Key Considerations
- Euglycemic DKA poses a challenge to physicians, as patients presenting with normal blood glucose levels in ketoacidosis may be overlooked, leading to a delay in appropriate management strategies 6.
- Despite euglycemia, ketoacidosis in diabetic patients remains a medical emergency and must be treated in a quick and appropriate manner 6.
- Clinician knowledge of this condition can improve the evaluation and management of patients with euglycemic DKA 5.