Diabetic ketoacidosis (regular insulin)
Child: 0.5-1 U/kg in 2 divided doses, 1 given IV and the other SC, then 0.5-1 U/kg IV q 1-2 h; or 0.1 U/kg IV bolus, then 0.1 U/kg/h IV infusion until blood glucose drops to 250 mg/dl; then start SC insulin.
Adult: Loading dose 0.15 U/kg IV, then 0.1 U/kg/h IV infusion. Decrease rate of insulin infusion at plasma glucose level 300 mg/dl. Infusion of D5W started separately from insulin infusion when plasma glucose 250 mg/dl; 30 min before stopping insulin infusion, give intermediate-acting insulin SC. Or 50-100 U IV and 50-100 U SC immed; then doses based on response and glucose, acetone, ketone levels (monitored q 1-2 h); or 2.4-7.2 U IV loading dose, then 2.4-7.2 U/h.
Ketosis-prone pt, type 1 DM, inadequately controlled DM
Child, adult: Individualize dose based on pt blood and urine glucose levels.
Hyperkalemia
Adult: 5-10 U regular insulin with 50 ml D5W over 5 min. Or 25 U regular insulin SC and infusion of 1,000 ml D10W with 90 mEq Na bicarbonate; infuse 330 ml over 30 min and the rest over 3 h.
Provocative test for growth hormone secretion
Adult: Rapid IV inj of regular insulin 0.05-0.15 U/kg. |