June Pearl #1 - Give the Long Acting Insulin Early in DKA patients

Pearl #1

Summary:

The typical DKA protocol of stopping the insulin infusion two afters the insulin drip is started was initially started when NPH was more commonly used as the “long acting insulin.” Since longer acting insulin like glargine (lantus) has become more common there is an increased risk of rebound hyperglycemia and re-opening the anion gap as the glargine takes longer to reach peak effect than NPH. Pearl # 1 covers some of the data and rationale for starting glargine when the insulin infusion begins. In theory starting long acting insulin early, rather than when the gap closes could help transition off the insulin drip faster to help with patient disposition to lower acuity areas of the hospital. This is particularly important when beds are tight in the hospital and boarding in the ED becomes an issue.

It is eloquently summarized in an article: https://emcrit.org/pulmcrit/early-basal-insulin/

Summary and Presentation by: John E. Schneider MD PGY4

Pearl from: Adam Koertner MD