The following algorithm is from a JAMA article in 2004. Here is the link: http://archinte.jamanetwork.com/article.aspx?articleid=217393
It helps give you a guide for determining how much insulin to give in insulin drip during DKA. Remember that insulin is dosed based on weight. E.g., In DKA, you give 0.1 U / Kg as IV bolus and then 0.1 U / Kg/hr IV continuous infusion. For example, for a 47kg patient, I rounded up to give 5 units /hr of continuous infusion. But one of DKA’s diagnostic criteria is a blood glucose of > 250. So the 5 units is good when blood sugar is high. You want to maintain blood sugar between 150 and 200 mg/dL until resolution of DKA. The following algorithm can help you. However, I would reduce the rate of infusion to keep the sugars between 150 and 200 and never let them go below that range until DKA resolves.
Note: Insulin drip usually comes as 100 units (of say insulin aspart) in 100 mL of NS. That is, one milliliter of that bag contains 1 unit of insulin in it. If you want to give 5 units of insulin in one hour, it means you will order that drip that is 100 units in 100 mL of NS and then put the rate of the drip at 5 cc / hr. That’s how the drip comes.
