A. Patients must receive exogenous insulin to prevent ketoacidosis.
B. Insulin can be given by sliding scale or continuous infusion.
1. Regular insulin: 50 U/250 cc NS = 0.2 units/cc (flush IV tubing before starting).
2. Insulin rate in U/hr = blood glucose/150 (use 100 as denominator if patient is on steroids, or is markedly obese, or infected). Alternative dosing. 0.1 units/kg/hr.
3. An IV of D5W (1-1.5 ml/kg/hr) should be started prior to insulin.
4. Adjust insulin infusion as needed to keep glucose levels between 120-180 mg/dL.
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