Subcutaneous Insulin Use in Diabetic Ketoacidosis

Authors

Patrick J. McGrath, University of Lynchburg, VirginiaFollow

Specialty

Emergency Medicine

Abstract

This review evaluates the clinical application of subcutaneous (SQ) insulin, particularly rapid-acting insulin analogs (RAIAs), in managing mild to moderate diabetic ketoacidosis (DKA). Standard treatment highlights fluid resuscitation, correcting electrolytes, and giving intravenous (IV) regular insulin at 0.1 units/kg per hour, often requiring intensive care unit (ICU) admission. Evidence from randomized controlled trials, meta-analyses, and multicenter cohort studies in adults indicates that SQ RAIAs have DKA resolution rates comparable to those of IV insulin, with similar total insulin needs and hospital length of stay. Rates of hypoglycemia were lower with SQ protocols, which also offered operational benefits like shorter emergency department stays and less ICU use. Meta-analyses support these results, indicating equal effectiveness and safety between SQ RAIAs and IV insulin in resolving DKA, with no differences in recurrence. The American Diabetes Association considers SQ RAIAs a safe and effective alternative for selected patients with mild to moderate DKA, as long as close monitoring and proper fluid management are maintained. Therefore, SQ insulin is a practical, resource-efficient option that could change practice in suitable clinical settings.

Recommended Citation

McGrath PJ. Subcutaneous Insulin Use in Diabetic Ketoacidosis. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).