Diabetic ketoacidosis is a severe insulin deficiency that causes the body to break down fat instead of glucose for energy, putting patients at risk for complications without insulin replacement. The document outlines guidelines for monitoring and treating patients with diabetic ketoacidosis via insulin drips, including defining diagnostic criteria, assigning patients to units based on stability, and delineating responsibilities of physicians, nurses, and other staff in titrating insulin drips and monitoring patients' blood glucose and response to treatment.

1. Insulin Drips
Diabetic Ketoacidosis is a severe insulin deficiency that leads
the body fat to obtain glucose
Without insulin, fluids and electrolyte replacement, patients
are at risk for life-threatening complications, including CNS
depression and coma
The patient with DKA may have a number of manifestations
The definitive diagnosis of DKA consists of:
• Hyperglycemia (> 250 mg/dl)
• Low serum bicarbonate (< 15 meg/L)
• Low pH (< 7.3) with ketonemia & moderate ketouria

2. Insulin Drips (continued)
Stable medical patients are monitored on a clinically appropriate
nursing unit
Stable pediatric patients are monitored on 3 South
Unstable patients are monitored in CCU
Physician’s responsibilities include:
 Decides if patient is stable enough to
be monitored on the floor or if they
will be monitored in CCU
 Writes specific orders for the Insulin
Drip

3. Insulin Drips (continued)
Licensed Practical Nurse responsibilities include:
• Monitor Blood Glucose as assigned by RN
• Notify RN of blood glucose results
Registered Nurse responsibilities include:
• Clarify orders PRN
• Initiates Insulin Drip (verified by 2 RN’s)
• Monitor blood glucose as ordered and PRN
• Titrate Insulin Drip as ordered
• Hang new Insulin Drip bags PRN

4. Insulin Drips (continued)
 Place Insulin Drip on IV pump as primary IV and
use drug list to increase patient safety
 If the patient has another IV order, these need to
be placed on separate pumps
 Insulin Infusions and pumps are clearly labeled
 Only Regular Insulin may be used for IV infusions