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DKA Insulin Management — RACP Adult Medicine MCQ

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EasyEndocrinologyDKA Insulin ManagementRACP Adult Medicine

A 40-year-old man with type 1 diabetes on an insulin pump (CSII) presents to the emergency department. His pump malfunctioned 6 hours ago and he has not received any insulin. Blood glucose is 28 mmol/L, pH 7.15, HCO₃⁻ 7 mmol/L, ketones 6.5 mmol/L. He is alert and oriented. What is the immediate insulin management?

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Correct answer: B — Fixed-rate IV insulin infusion (0.1 units/kg/hr)

DKA requires fixed-rate IV insulin infusion (0.1 units/kg/hr) regardless of the patient's usual insulin delivery method. The insulin pump should be disconnected, as absorption from the pump site may be unreliable during the acute illness. IV insulin provides predictable delivery. Continue IV insulin until ketones <0.6 mmol/L and patient is eating, then transition to subcutaneous insulin (with 30-minute overlap).

Reference: ADS – 2024 – DKA Protocol; JBDS-IP 2024 DKA Guidelines