Diabetic Ketoacidosis (DKA): Management with Insulin (Nursing)

00:01 Now when you're giving insulin, you want to make sure, we already talked about, that that patient's potassium is greater than or equal to 3.5.

00:07 So, if it is, you can give the regular insulin using either regimen or plan.

00:12 You can either give fixed rate continuous IV, or you can do variable rate continuous IV. Okay.

00:19 So let's take a look at what the difference is.

00:21 Now if you're in fixed rate continuous IV infusion, be something like 0.1 units per kilogram per hour.

00:28 Now, if you're establishing venous access and it's delayed and you can't get that done, you might end up giving an IV of 0.1 unit per kilogram bolus before you start the continuous infusion.

00:40 But typically, a fixed rate meaning it stays the same rate and IV is continuously being infused into that patient, you're going to give 0.1 units per kilogram.

00:51 So you'll do the math on that and figure out what the appropriate dose is.

00:54 Now, for some reason, there's a delay, that's why we talked about you might end up giving a bolus before you start that IV infusion that's constant.

01:03 Now there's a variable rate continuous IV infusion.

01:07 This is pretty cool.

01:08 because it's a nurse-driven protocol.

01:12 That means the healthcare providers have come together, they've determined what the DKA protocol is, and they want a variable rate.

01:20 So they've written out exactly how the rate of the IV infusion of insulin should be changed and adjusted based on the client's lab work and clinical symptoms.

01:29 So that's pretty fun if you get to do that, that's in a critical care unit.

01:33 You've got really nice guardrails of a guideline and a protocol, and that's fun when you get to do that.

01:39 But either way is going to be successful in helping to treat this patient.

01:43 Just one you're a little more involved in making decisions than the other one.

01:47 Either way you go, fixed rate continuous IV infusion or variable rate based on you following a protocol that you're driving, it was written by healthcare providers, but you're driving it, this is what's going to help keep that patient moved toward health and you need to have an ongoing conversation with the healthcare provider.

02:06 Now, let's look at a fixed rate infusion.

02:08 If this is what you're doing, you're following a specific order where you're giving a fixed rate of 0.1 units of insulin per kilogram per hour.

02:17 Then you're going to keep an eye on that serum glucose.

02:19 If it doesn't fall by at least 50 to 70 in the first hour, you're likely going to end up increasing that rate of insulin.

02:27 Now when the serum glucose is less than 250, you're going to decrease that infusion rate to 0.05 units per kilogram per hour because we don't want to drop them down too fast and too low.

02:38 You're going to make further adjustments to that rate of the insulin as the glucose becomes more stabilized.

02:44 So we're looking for the patient to be at least 50 to 70, a drop in their blood glucose in the first hour of being on the IV.

02:53 When the serum glucose is less than 250, we know we're going to decrease the infusion rate.

02:59 And third, when the client gets to about 200, we're also going to adjust the rate.

03:04 So, you'll either have specific orders on when to do that at those guardrails, or you'll have to contact the healthcare provider.

03:12 Now you're going to continue the insulin infusion until the ketoacidosis is resolved.

03:17 So you want the serum glucose to be below 200 and then you can move to subcutaneous insulin.

03:22 So you can move off the IV insulin infusion until you get that glucose below 200, got that ketoacidosis resolved, and you can switch to subcutaneous insulin.