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

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...

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 served...

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, most...