Should long-acting subcutaneous insulin be started upfront in addition to regular insulin infusion for patients with diabetic ketoacidosis?  

After years of experience, our hospital has criteria for starting/managing DKA with subcutaneous insulin, so in those patients, yes, you can add a long-acting sub q insulin with regular insulin. In patients who are complicated, have a pH that is <7.1, or co-morbidity such that they are better ser...

There is a risk of hypoglycemia when using both an insulin drip plus long-acting subcutaneous insulin. Insulin drip is the mainstay for correcting diabetic ketoacidosis, and there needs to be a continuous, minute-by-minute shift of glucose into cells so the cells can utilize glucose and so there can...

I would not. According to the DKA protocol with insulin infusion, the dose of IV insulin infusion is based on the trend of glucose. If long-acting SQ insulin is added, the faster downtrending of glucose may lead to less dose of IV insulin, which may result in a reopening of the anion gap. Also, mo...

Current ADA guidelines suggest patients with uncomplicated mild or moderate DKA may be treated with subcutaneous rapid-acting insulin analogs every 1-2 hours as an effective alternative to IV insulin, but still only recommend IV short-acting insulin by continuous infusion for moderate-severe DKA. Ho...