If working in a location where continuous intravenous insulin infusion cannot be administered the American Diabetes Association position statement suggests that 0.4 units of fast acting insulin/kg body weight be given, half as an intravenous bolus, half subcutaneously or intramuscularly, and then that 0.1 units/kg are given intramuscularly each hour until plasma glucose is less than 14 mmol/l. At this stage 5–10 units of fast acting insulin are administered every two hours, with concomitant dextrose infusion, until normal insulin can be started.35 It should be stressed, however, that the studies with the lower mortality rates have all been conducted in centres using intravenous insulin infusion