Insulin Dosing for Recurrent DKA Patient

Introduction to Insulin Therapy

• The American Diabetes Association recommends aggressive insulin intensification for patients with recurrent DKA, with a basal-bolus regimen and substantially increased total daily insulin dose to prevent mortality 1, 2

Basal Insulin Dosing

• The American Diabetes Association suggests increasing Lantus to 40-50 units daily, approximately 0.5-0.65 units/kg for a 77 kg weight, with a starting dose of 40 units and titrating up to 50 units based on fasting glucose monitoring 1, 3

Carbohydrate Ratio and Prandial Insulin

• The American Diabetes Association recommends starting with a 1:10 ratio of rapid-acting insulin to carbohydrates before each meal, with approximately 5-8 units per typical meal, and adjusting the ratio every 2-3 days based on 2-hour postprandial glucose readings 3, 4

Correction Scale and Insulin Sensitivity Factor

• The American Diabetes Association suggests using 1 unit of rapid-acting insulin to lower blood glucose by 50 mg/dL, with a target blood glucose of 100-150 mg/dL, and adjusting correction doses based on glucose levels 1, 3

Complete Daily Insulin Regimen

• The American Diabetes Association recommends a total daily dose of approximately 80-100 units, with 40-50 units of basal insulin and 30-50 units of prandial insulin, divided across 3 meals, and correction doses as needed 1, 3

Monitoring and Titration Schedule

• The American Diabetes Association suggests increasing Lantus by 2-4 units every 3 days if fasting glucose is greater than 130 mg/dL, adjusting carb ratios if postprandial glucose is consistently greater than 180 mg/dL, and tightening the correction factor to 1:40 if corrections are ineffective 3