This is not my own work. It was written down by a vet at an emergency centre where I did a locum.
I always struggle to get my head around the correct approach to stabilise a newly diagnosed diabetic with (or without) DKA, so will find this most useful. This protocol is used for a symptomatic DKA dog.
Maintain hydration
Keep on top of changes in electrolytes
Aim to get BG between 10 to 15 mmol/L and keep it there
INSULIN admin:
Aim to drop BG approx 3 mmol/L per hour to prevent cerebral oedema.
Insulin type = regular rapid acting insulin - usually 100 IU/ml. NB use correct insulin syringe!
Initial dose = 0.2 IU/kg IM
Then every hour: take BG and inject 0.1 IU/kg IM ongoing until BG is between 10 and 15.
Once this happens - change fluids to
0.45% saline with 5% dextrose
Change IM injections to every 4-6 hours
alter depending on what you need.
Ensure well hydrated at all times
Continue until eating and drinking with no vomiting
Only then change to twice daily dosing with intermediate acting insulin.
Other option is CRI
Piggy back insulin fluids into the maintenance fluids using a separate infusion pump and allow 50 ml to run through the tube before attaching as insulin binds to plastic.
Dose is 2.2 IU/kg/day or regular insulin for dogs and 1.1 IU/kg/day for cats.
Add to 0.9% saline.
Rate @ 10ml/hr
BG monitoring every 1 - 2 hours.
Need other fluid as well to maintain hydration.
Once BG is between 10 to 15: change main fluid to 0.45% saline with glucose 2.5% and run insulin drip at 7ml/hr,
Once BG drops below 10, drop rate to 5ml/hr.
If BG drops below 5, change to 5% glucose and stop insulin infusion.
