Question

A 43-year-old with T2DM presents with DKA: glucose 420 mg/dL, pH 7.18, bicarbonate 12, anion gap 22, K+ 4.6. After initial 1-1.5 L isotonic saline, what insulin strategy is recommended?

Accepted Answer

IV regular insulin infusion 0.1 U/kg/h (with optional 0.1 U/kg bolus)

Answer

Subcutaneous rapid-acting insulin every 2 hours

Answer

No insulin until glucose <250 mg/dL

Answer

Start insulin infusion 0.5 U/kg/h

Answer

Start insulin only after bicarbonate is >18 mEq/L

Practice question

A 43-year-old with T2DM presents with DKA: glucose 420 mg/dL, pH 7.18, bicarbonate 12, anion gap 22, K+ 4.6. After initial 1-1.5 L isotonic saline, what insulin strategy is recommended?