PedsCrit Diabetic Ketoacidosis with Dr. Nicole Glaser
Oct 27, 2025
Dr. Nicole Glaser, Chief of Pediatric Endocrinology at UC Davis, shares her expertise on managing pediatric diabetic ketoacidosis (DKA). She discusses best practices for triaging DKA patients and explains the critical risks associated with cerebral injury. Dr. Glaser highlights the importance of fluid management and the evidence supporting insulin infusion rates. She also addresses when to transition to subcutaneous insulin and the benefits of continuous glucose monitors in managing children recovering from DKA. Vigilant monitoring and reassessment are key takeaways.
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Career Spark From A Single Case
- Dr. Nicole Glaser became fascinated with DKA after a resident case where a child developed cerebral injury and the explanations felt unsatisfying.
- That single patient motivated her career focus on DKA research and endocrinology.
Bolus First, Reassess Before Hyperosmolar
- Give an initial 10–20 mL/kg normal saline bolus and reassess mental status before deciding on hyperosmolar therapy.
- Reserve CT for suspected alternative intracranial pathology or impending herniation, not routine decisions on therapy.
Inflammation And Reperfusion Drive Injury
- Contemporary data point away from rapid osmotic shifts as the main cause of cerebral injury in DKA.
- Inflammation plus cerebral hypoperfusion/reperfusion likely drive blood-brain barrier disruption and injury.