Most Stable Patients with Diabetic Ketoacidosis Don't Require ICU Admission

Diabetic ketoacidosis (DKA) typically is managed in a step-down unit or intensive care unit (ICU), given the safety protocols necessary for administering intravenous (IV) insulin. However, given limited ICU bed availability, patients with mild-to-moderate DKA often board in the emergency department (ED).

Researchers conducted a prospective, nonrandomized study of 84 adults (mean age, 45) with mild-to-moderate DKA in an urban St. Louis ED. Sixty-two patients were started on the subcutaneous insulin in DKA protocol (SQuID; subcutaneous insulin every 2 hours along with fluid support), with most admitted to an observational unit or medical floor; 22 patients received traditional IV insulin infusion, mostly in an ICU. Patients with severe DKA (ve…