Continue basal insulin in patients on basal bolus insulin regimen. Switch off continuous subcutaneous insulin pump if the patient has one. - Make 50 units of soluble insulin up to 50 mL with normal saline (i.e. insulin 1unit/mL). Flush 10 mL of the solution through the line before connecting to the patient (as some insulin will be adsorbed onto the plastic).
- Start the infusion at 0.1units/kg/hr. Check hourly capillary blood glucose and ketones, send venous glucose if capillary blood glucose meter reads ‘high’.
- Aim for blood ketones to fall by 0.5 mmol/L/h. If blood ketones do not fall, increase insulin infusion in 1unit/h increments until blood ketones fall by at least 0.5 mmol/L/h. If there is no fall in blood ketones or glucose, confirm that the pump is working and the IV line is connected properly. Consult diabetes specialist team if blood ketone levels are still not falling.
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