A 58-year-old man on ICU has been receiving IV insulin for DKA management for 18 hours. His blood glucose is now 12 mmol/L (down from 38 mmol/L). Howe...

Question

A 58-year-old man on ICU has been receiving IV insulin for DKA management for 18 hours. His blood glucose is now 12 mmol/L (down from 38 mmol/L). However, his pH remains 7.22 and ketones are 4.5 mmol/L. According to the JBDS DKA protocol, should the insulin infusion be stopped?

Accepted Answer

No - continue the insulin infusion (and add 10% dextrose to prevent hypoglycaemia) until ketones are  7.3 AND bicarbonate >15 mmol/L

Answer

Yes - the blood glucose is approaching normal so insulin should be stopped

Answer

Reduce the insulin infusion to 0.02 units/kg/hr

Answer

Stop insulin and switch to subcutaneous insulin immediately

Answer

Stop insulin and commence IV sodium bicarbonate to correct the acidosis

uk-fficm MCQ (SBA): Diabetic Ketoacidosis

A 58-year-old man on ICU has been receiving IV insulin for DKA management for 18 hours. His blood glucose is now 12 mmol/L (down from 38 mmol/L). However, his pH remains 7.22 and ketones are 4.5 mmol/L. According to the JBDS DKA protocol, should the insulin infusion be stopped?