WHAT TO DO AFTER RECOVERY FROM DKA
I. The patient is kept NPO until recovery from DKA has been achieved (VBG
pH >7.3, with and a HCO3 > 18). Continue with IV fluids until the child is
drinking well and able to tolerate food.
II. Give the initial dose of SC insulin 30 minutes before discontinuing the IV
insulin.
Established patient
Patient will be able to resume their usual dose of insulin unless information in the
medical history suggests otherwise.
New patient
Option 1
Regular (R) insulin can be given SC before each meal and as needed overnight for 24
hours. Remember that since R lasts 4-6 h, a patient receiving no long acting insulin
may need a small dose of R during the night in order to prevent the possible rapid
return of DKA due to the ongoing catabolic state.
The initial dose of insulin can be 0.25 unit/kg/dose with adjustment made in
subsequent doses depending on the response of the blood glucose to the previous
injection (s). The total dose of R insulin for the 24 hour period is then divided into
two doses. (2/3 of the dose in the AM and 1/3 in PM with 2/3 of each dose as
intermediate acting insulin and 1/3 as R insulin)
Option 2
Mixed insulin can be given SC before breakfast or dinner. The initial dose of insulin
can be 0.8-1 unit/kg/day (2/3 of the dose in the AM and 1/3 in PM with 2/3 of each
dose as intermediate acting insulin and 1/3 as R insulin.)
Child under 5 years of age.
A lower initial dose of Regular insulin is recommended (0.1 unit/kg/dose) or 0.5
unit/kg/day.
Sliding scale can be used. (please see how to determine a sliding scale in Multiple
dose insulin regimen.)
Guideline for Intensive insulin regimen.
Established patient
Patient will be able to resume their usual dose of insulin unless information in the
medical history suggests otherwise.
Initiation of intensive insulin regimen
Insulin Pump Therapy
Total daily insulin requirement is 20-30% less than conventional insulin therapy
Determination of Basal rate
Approximately 50% of total daily insulin requirement.
Basal rate = Total daily insulin requirement (unit)
unit/hour
24 hours
Determination of Bolus
0.5 - 3 unit per 15 grams of carbohydrate (1 Carb or carbohydrate exchange = 15
grams)
Determination of Correction factor (sensitivity factor, supplement insulin ratio)
Correction factor = Total daily insulin requirement
1500
Amount of extra insulin to be given = Actual blood sugar – Target blood sugar
Correction factor
Multiple dose insulin injection
Determination of Basal insulin
Lantus is given once a day as basal insulin and can not mixed with other types of
insulin.
Lantus insulin to be given = Basal insulin rate (unit/hour) x 24
or
= 50 % of Total insulin requirement
Determination of Bolus
0.5 - 3 unit per 15 grams of carbohydrate (1 Carb or carbohydrate exchange = 15
grams)
Determination of sliding scale
Use the correction factor to determine sliding scale and round off insulin doses to
nearest ½ or whole unit.
e.g. correction factor = 1 unit per 50 mg/dl of blood sugar
Blood sugar 151 - 200 mg/dl
1 unit
201- 250 mg/dl
2 units
and so on.