Dose of insulin
We usually give a bolus of six units then an infusion of 6 units/h when starting treatment of an adult with DKA (0.1 units/kg for patients who weigh less than 60 kg). Higher doses are associated with an increased risk of hypoglycaemia. A tar- get reduction in [glucose] of 5 mM/h has been suggested though this has not been subjected to evaluation.9 Rather than using a “sliding scale”, we suggest that an infusion rate is started and then reviewed by a doctor every one to two hours (they should be reviewing the patient at least this frequently anyway). This is analagous to reviewing hypotensive or shocked patients frequently rather than prewriting their fluids for several hours.