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Table 83.6

Switching from IV to SC Insulin after Resolution of Diabetic Ketoacidosis

  1. Resolution of DKA requires a venous pH >7.3 and blood ketones <0.6 mmol/L.
  2. In patients already on basal bolus regime, the basal dose should have been continued throughout the DKA treatment.
  3. In patients newly diagnosed with diabetes, start a long-acting insulin 0.25units/kg and request diabetes specialist team input.
  4. 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.
  5. 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.
  6. Check blood glucose before meals and at 2200h, and adjust doses of insulin as needed, aiming for levels 4–7 mmol/L.
  7. Refer to diabetes team for advice on further management.