The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast
Episode 117. Early Subcutaneous Basal Insulin in Mild to Moderate DKA: A Discussion with Tessa and Brian
Aug 13, 2024
Brian W. Gilbert, PharmD, MBA, FCCM, FNCS, BCCCP, and Tessa R. Cox, PharmD, BCCCP, are experts in emergency medicine and DKA management. They dive into their groundbreaking study on the early use of subcutaneous insulin in mild to moderate DKA, revealing no significant difference in hospital stays between early and later treatment. The duo also discusses updated diagnostic criteria, management strategies, and the potential benefits of long-acting insulin, emphasizing the need for enhanced care protocols in emergency settings.
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Quick takeaways
- The early administration of subcutaneous basal insulin in DKA may lead to faster recovery times, despite no significant length of stay reduction.
- A call for further research highlights the need for larger studies to validate the safety and efficacy of early insulin therapy in DKA management.
Deep dives
Understanding Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is characterized by a specific triad of symptoms: hyperglycemia, ketonemia, and metabolic acidosis. It affects both type 1 and type 2 diabetics and is primarily caused by insulin deficiency and increased levels of counter-regulatory hormones. The diagnostic criteria include a blood glucose level above 200, elevated ketone levels, and a pH less than 7.3, indicating acidemia. Managing DKA begins with fluid resuscitation and administering insulin, traditionally through intravenous methods; however, new guidelines suggest considering subcutaneous insulin for certain cases.
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