Insulin administration and DKA... PLZ HELP

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I am having a test over this on Tues. One of the study questions is as follows:

A patient is in DKA, which route for insulin administration should be used?

a. SQ

b. IV

I keep finding contradicting answers. Lewis medsurg edition 7 says that "Insulin therapy is witheld until fluid resuscitation is underway. Initially a bolus of insulin is delivered, followed by a continuous infusion."

This does not tell me whether if the bolus of insulin is in IV or Sub Q. Any insight would be greatly appreciated. Thanks

Specializes in CVICU, ER.

WoW!! Thanks for all of the wisdom. :thankya: I knew I would find it here at allnurses. My test is Tuesday and after all of these resources, I will know it for sure for my test! Thanks again.

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Specializes in Geriatrics, Triage, Cardiac ICU.

If I'm not mistaken, IV insulin and fluids are usually always used in cases of DKA...it is very important to get the BS down and the FVD under control.

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I had the same question on an exam.

Insulin is given continuous iv drip, until ketones levels are under control. simultaneously with fluid volume replacement..there may come a point when the glucose level is under control but the ketone levels are not, at that point iv insulin is continued and fluid replacement is switched to a dextrose containing solution (D5W) to maintain glucose levels until ketones are corrected..:twocents:

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Specializes in CVICU, ER.

Thanks to all for the info!! I am happy to say that with much studying (and all of your help here at allnurses) I have taken this test today, and the tentative grades are in! I made an AAAAAAAAAA YAY!! I am ecstatic. There were 12 endocrine disorders on a 50 question test, with more than half being DM I & II. I am so excited!! Thanks again to all of you that help all of us who just want to make a difference like you!!! God Bless :)

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Congratulations, rwright15

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Specializes in Critical Care.
Correct. SubQ absorption is decreased secondary to dehydration.

You also can't titrate sub-Q hourly based on glucose.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Congrats on making your A!

Just a word to others reading this thread. . .Diabetes is so prevalent that you need to know its pathophysiology and complications. For endocrine you are going to get tested thoroughly over Type I and II diabetes and its treatment so you have got to know it. It is a complicating problem that many patients will have along with their primary admitting diagnosis.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
You also can't titrate sub-Q hourly based on glucose.

Right.

Here's an algorithm for tx DKA in the adult with sub-q insulin.

Start with 0.4 units/kg - 1/2 IV, 1/2 sub-q.

Then, 0.1 units/kg/hour sub-q.

If after the first hour BS doesn't drop approximately 50 mg/dl, should switch to hourly IV bolus (10 units) until BS drops approximately 50 mg/dl.

When BS drops to 250, give sub-q (5 - 10 units/24 hours) to keep BS between 150 and 200.

The above is for uncomplicated DKA and usually will not require ICU admission.

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