Switching from IV to SC Insulin after Resolution of Diabetic Ketoacidosis
- Resolution of DKA requires a venous pH >7.3 and blood ketones <0.6 mmol/L.
- In patients already on basal bolus regime, the basal dose should have been continued throughout the DKA treatment.
- In patients newly diagnosed with diabetes, start a long-acting insulin 0.25units/kg and request diabetes specialist team input.
- Half of the total daily dose should be as long-acting insulin SC at evening. Divide the remaining half into three to calculate the dose of short-acting (soluble) insulin SC before meals.
- Once DKA has resolved and patient is able to eat, give the fast-acting insulin with a meal and stop the intravenous fixed rate insulin one hour later.
- Check blood glucose before meals and at 2200h, and adjust doses of insulin as needed, aiming for levels 47 mmol/L.
- Refer to diabetes team for advice on further management.
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