- Give a correction bolus via the insulin pump
- Recheck glucose level in 1 hour
If glucose level is >12 mmol/L, give another correction bolus
If glucose level is 4 – 12 mmol/L, plan to discharge patient on their insulin settings
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Give a correction bolus
- Use the usual pump settings OR
- Use 1 unit to lower glucose level by 2 mmol/L
Increase the basal rate by 50% Ensure Dextrose fluids are running:
- 4% Dextrose 0.18 Normal Saline @ 125ml per hour
- If the patient can drink, give Hydralyte, 250ml stat
- Give a correction bolus via the insulin pump
- Check IV Dextrose is running
- If the patient can drink, give Hydralyte, 250ml stat
- Recheck glucose level in 1 hour
- Recheck ketones in 2 hours
If glucose is >12 mmol/L
- Give another correction bolus. Estimated that 1 unit will lower glucose by 2 mmol/L
- Increase the insulin basal rate by 20% for the next 4 hours
If glucose level is 4 – 12 mmol/L
- Patient can be discharged
- Continue usual basal rates
If your patient can eat, eat some low-GI carbohydrate with bolus for that serve of carbohydrate Eg. Glass of milk Tub of yoghurt 1 slice of bread 2 dry, sweet biscuits
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Give a correction bolus
- Use the usual pump settings OR
- Use 1 unit to lower glucose level by 2 mmol/L
Increase the basal rate by 50% Ensure Dextrose fluids are running:
- 4% Dextrose 0.18 Normal Saline @ 125ml per hour
- If the patient can drink, give Hydralyte, 250ml stat
If your patient can eat, eat some low-GI carbohydrate with bolus for that serve of carbohydrate Eg. Glass of milk Tub of yoghurt 1 slice of bread
Treat the Diabetic Ketoacidosis:
- Give Normal Saline 500ml/hour stat
- Check venous blood for pH, HCO3, potassium
- Check the pump, pump cannula, pump tubing etc
- Contact Endocrinology registrar or treating physician
- Set up intravenous insulin infusion to replace pump
- Patient requires hospital admission for management of DKA
- Postpone procedure until patient is well
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