What is a suitable subcutaneous insulin regimen for an 80kg male hospitalized with diabetic ketoacidosis (DKA)?

From the Guidelines

For an 80kg male hospitalized with diabetic ketoacidosis (DKA), a suitable subcutaneous insulin regimen is to administer 0.1 units/kg rapid-acting insulin analog as a subcutaneous bolus every 1 hour or 0.2 units/kg every 2 hours 1.

Key Considerations

• The patient's blood glucose levels should be monitored every 2-4 hours to adjust the insulin regimen accordingly 1.
• The goal is to keep glucose between 150 and 200 mg/dL until resolution of DKA 1.
• It is essential to check electrolytes, renal function, venous pH, osmolality, and glucose every 2–4 h until stable 1.
• After resolution of DKA and when the patient is able to eat and drink, initiate a subcutaneous multidose insulin plan 1.

Insulin Administration

• The initial subcutaneous insulin dose can be calculated based on the patient's weight, with 0.1 units/kg being a suitable starting point 1.
• The use of rapid-acting insulin analogs can help to achieve tighter blood glucose control 1.
• It is crucial to continue i.v. insulin infusion after starting subcutaneous insulin to ensure a smooth transition 1.

From the FDA Drug Label

The maximum glucose-lowering effect of Insulin Aspart occurred between 1 and 3 hours after subcutaneous injection (0. 15 units/kg). The duration of action for Insulin Aspart is 3 to 5 hours.

For an 80kg male hospitalized with diabetic ketoacidosis (DKA), a suitable subcutaneous insulin regimen using insulin aspart could be:

• An initial dose of 0.15 units/kg (12 units for an 80kg male)
• Administered subcutaneously every 3 to 5 hours as needed to control glucose levels
• Monitoring of blood glucose levels is crucial to adjust the dose and frequency of administration as needed 2

From the Research

Subcutaneous Insulin Regimen for Diabetic Ketoacidosis (DKA)

• The use of subcutaneous insulin aspart every 1 or 2 hours has been shown to be a safe and effective alternative to intravenous regular insulin in the management of patients with uncomplicated DKA 3.
• A study on pediatric DKA found that subcutaneous regular insulin administered every 4 hours is an effective and safe alternative for the insulin treatment of DKA with pH > 7.0 in children 4.
• For adults, a basal bolus regimen with glargine and glulisine after resolution of DKA resulted in similar glycemic control but in a lower rate of hypoglycemia than with NPH and regular insulin 5.
• In children and adolescents, a higher initial dose of 1.4-1.5 U/kg/day regular insulin after resolution of DKA was associated with better glycemic control without an increase in risk of hypoglycemia 6.
• A study from 1977 found that the optimal route of insulin administration for DKA is by initial intravenous combined with subcutaneous or intramuscular, with no significant differences in the rate of decline of plasma glucose or ketones after the first two hours 7.

Dosage Considerations

• The dosage of subcutaneous insulin for an 80kg male hospitalized with DKA would depend on various factors, including the patient's insulin sensitivity and the severity of the DKA.
• A dose of 1.4-1.5 U/kg/day regular insulin, as used in the study by 6, would translate to approximately 112-120 units per day for an 80kg male.
• However, this dose may need to be adjusted based on the patient's individual response to insulin therapy and their blood glucose levels.

Administration Frequency

• Subcutaneous insulin aspart can be administered every 1 or 2 hours, as shown in the study by 3.
• Subcutaneous regular insulin can be administered every 4 hours, as shown in the study by 4.
• The frequency of administration may need to be adjusted based on the patient's individual response to insulin therapy and their blood glucose levels.