Diabetes Mellitus Q 10

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Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

  

    A. Subcutaneous

    B. Intramuscular

    C. IV bolus only

    D. IV bolus, followed by continuous infusion

    

    

Correct Answer: D. IV bolus, followed by continuous infusion.

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An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. Previous treatment protocols have recommended the administration of an initial bolus of 0.1 U/kg, followed by the infusion of 0.1 U/kg/h. A more recent prospective randomized trial demonstrated that a bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.

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Option A: After the client is stabilized, subcutaneous insulin is given. Treatment of adult patients who have uncomplicated, mild diabetic ketoacidosis can be treated with subcutaneous insulin lispro hourly in a non-intensive care setting may be safe and cost-effective as opposed to treatment with intravenous regular insulin in the intensive care setting as shown in many studies.

Option B: Insulin is never given intramuscularly. In one of these studies, the patients received subcutaneous insulin lispro at a dose of 0.3 U/kg initially, followed by 0.1 U/kg every hour until blood glucose was less than 250 mg/dl. Then insulin dose was decreased to 0.05 or 0.1 U/kg given every hour until the resolution of DKA.

Option C: Intravenous insulin by continuous infusion is the standard of care. When the plasma glucose reaches 200-250 mg/dl, and if the patient still has an anion gap, then dextrose-containing fluids should be initiated, and the insulin infusion rate may need to be reduced.

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