Early Basal Insulin Administration in Adult Diabetic Ketoacidosis Management
Early Basal Insulin Administration in Adult Diabetic Ketoacidosis Management
The transition from IV Insulin Infusion (IVII) to Subcutaneous Long-acting insulin injections
 in Diabetic Ketoacidosis (DKA) management frequently results in rebound hyperglycemia,
 particularly if there are high insulin requirements that can adversely affect the DKA
 recovery, increase Length Of Stay (LOS), morbidity, and mortality. Investigators propose a
 prospective, open-label, intervention, non-randomized, controlled study to test the
 hypothesis that an insulin glargine dose of 0.4 Units/kg early administered (within four
 hours) of IVII initiation in DKA management in adult would be effective and safe in
 shortening the time to anion gap closure comparing to the standard practice.
Inclusion Criteria:

 -  Age ≥ 18 years old

 -  Meet DKA definition (BG ≥ 250 mg/dl, Anion Gap > 12 mEq/L, and positive Ketones in
 serum or urine)

 -  Having the capacity to sign Informed consent

 Exclusion Criteria:

 -  IV insulin infusion was initiated for more than 4 hours.

 -  Persistent hypotension (SBP<80 mmHg despite receiving 1000cc normal saline).

 -  Require Vasopressor

 -  Acute Coronary Syndrome

 -  Pregnant

 -  End-stage renal disease

 -  Unwilling to consent to participate in the trial

 -  Currently under police custody

 -  Transferred from another hospital

 -  Require emergent surgery