This is from the Yale Diabetes Center Diabetes Facts & Guidelines:
DKA (Adults Only): Day 1 Goals
Stabilize hemodynamics, replete volume, correct acidosis/electrolytes, search for precipitating cause.
Give R insulin 10 units IV bolus, then run insulin drip @ 5 - 10 units per hr. Goal is to decrease glucose by 50 - 75 mg/dl/hr. If BG is decreased by > 100 mg/dl/hr, reduce drip by 25 - 50%. If even greater BG drop occurs, hold drip for 1 hr and restart at 50% of prior rate. Check BG q 1 hr, and adjust drip as needed.
IV NS to replete fluid aggressively. Consider IV NaHCO3 if pH < 6.9 & HCO3 <5. Add K to IV fluids once K < 5.5, pt NOT in renal failure and adequate urine output documented. (FOLLOW SERUM K CLOSELY & REPLETE AGGRESSIVELY).
Once BG < 250 mg/dl, clamp* the glucose at 200 - 250 with 1 - 2 units insulin and 5 - 10 g dextrose per hr. (D5 -D10 @100 cc/hr until anion gap is closed (12 or lower)
Day 2: Leave on insulin drip is still NPO. To switch from IV to sub q insulin, maintain drip 1 - 2 hrs after initial sub q injection. (t1/2 of regular insulin IV is very short, so need to have time for SQ insulin to work.
*With HHS, no need to clamp since no acidosis.Leave on IV insulin until BG <200 and pt ready to eat. Often better to wait to start SQ insulin until next day at breakfast.
I realize this isn't a step by step scale to adjust drip based on BG. I'll get one from work tomorrow. Is there not a good endo to consult at your facility?
Last edit by Myxel67 on Apr 4, '07