How would you approach a situation where you had high clinical suspicion for DKA in a diabetic patient with severe hyperglycemia and elevated anion gap but normal serum pH and bicarbonate?

When would you initiate DKA-directed insulin for suspected DKA with severe hyperglycemia, an elevated anion gap, and normal pH and bicarbonate?

• On high clinical suspicion, while ketones are pending
• After confirming significant ketonemia
• Only after repeat testing demonstrates low pH or bicarbonate
• Other