What insulin regimen is recommended for the acute management of DKA, and how should it be adjusted based on blood glucose levels?

For the acute management of diabetic ketoacidosis (DKA), start an intravenous insulin infusion at a dosage between 0.05 units/kg/hour and 0.1 units/kg/hour, without bolus doses, and begin this infusion 1 to 2 hours after starting intravenous fluids ⁶.

If using an insulin pump, disconnect it when starting intravenous insulin therapy and restart it at least 60 minutes before stopping intravenous insulin, ensuring a new cartridge and infusion set are used ⁶.

When plasma glucose falls below 14 mmol/l, switch fluids to 0.9% sodium chloride with 5% glucose and 40 mmol/l potassium chloride ⁶.

If plasma glucose drops below 6 mmol/l during treatment, increase the glucose concentration of the IV fluids and continue insulin at at least 0.05 units/kg/hour if ketosis persists ⁶.

Adjust insulin dosage if beta-hydroxybutyrate levels are not decreasing within 6 to 8 hours, considering increasing insulin to 0.1 units/kg/hour or more ⁶.