Transitioning from IV to Subcutaneous Insulin in DKA

Introduction to Transitioning

• The American Diabetes Association recommends starting Lantus (insulin glargine) 1-3 hours before discontinuing the IV insulin infusion, once the patient's DKA has resolved and they are able to eat, to prevent rebound hyperglycemia and recurrent ketoacidosis 1

Timing the Transition from IV to Subcutaneous Insulin

• The critical principle is overlap: subcutaneous basal insulin must be administered while IV insulin is still running to prevent rebound hyperglycemia and recurrent ketoacidosis, as recommended by the American Diabetes Association 1

Monitoring During Transition

• The American Diabetes Association recommends checking blood glucose every 2-4 hours after starting Lantus until stable, and verifying DKA resolution parameters (pH, bicarbonate, anion gap) before stopping IV insulin 1
• Ensure adequate oral intake before transitioning, as the patient needs to be able to eat to match prandial insulin coverage, according to the American Diabetes Association 1

DKA Resolution and Insulin Administration

• Wait for DKA resolution before initiating the transition, defined as: bicarbonate >15 mmol/L, as recommended by the American Diabetes Association 1
• Continue IV insulin infusion until the patient's glucose reaches 150-200 mg/dL range, and DKA resolution parameters are met, before considering the transition, as recommended by the American Diabetes Association 1