Indication
DKA, HHS, hyperkalaemia, post-op glycaemic control.
Preparation
50 units regular insulin in 50 mL 0.9% NaCl (1 unit/mL). Flush 20 mL to saturate tubing.
Dilution
50 U / 50 mL NS → 1 U/mL
Rate
DKA: 0.1 U/kg/h (no bolus). Adjust to glucose fall 50–75 mg/dL/h.
Monitoring
- • Capillary glucose hourly
- • K⁺ q2–4 h
- • Anion gap / ketones
- • Fluid balance
Common errors
- • Stopping insulin before anion gap closes → relapse
- • Hypokalaemia not corrected before insulin start
Pearls
- • Add D5W when glucose <250 mg/dL — don't stop insulin
- • Bridge to subcut overlap by 1–2 h
