Evaluation and Treatment of Diabetic Ketosis without Acidosis — Insulin Dosing — Clinical Pathway: Inpatient

Diabetic Ketosis without Acidosis Clinical Pathway — Inpatient

Rapid Acting Insulin Bolus Calculations

Administer ketone dose or correction bolus, whichever is greater, but not both.

Calculation Description Equation
Ketone Dose Dose of rapid-acting insulin (aspart) given every 2 hrs to prevent progression to ketoacidosis when ketones present
  • Estimating the ketone dose using TDD (Total Daily Dose)
    • 10% of TDD of insulin
    • TDD can be estimated by Lantus dose x 2.25
  • ED Initial dose
    • Weight-based: 0.15 units/kg
  • TDD is unknown
    • Weight-based: 0.1 units/kg
  • Administer
    • Give ketone dose or correction bolus, whichever is greater
    • Do not give both
    • If patient due to eat, use ketone dose and cover carbohydrates
Insulin Sensitivity Factor
(Correction Factor)		 Amount in mg/dL that blood glucose is lowered by 1 unit of insulin
  • Refer to Endocrine letter
  • For new-onset DM or unknown correction factor
    • 1800/TDD of insulin
Correction Bolus Rapid-acting insulin dose given to lower blood glucose to a specified target
  • (Current Blood Glucose − Target Blood Glucose)
    Insulin Sensitivity Factor
Insulin to Carbohydrate Ratio Amount of insulin that covers carbohydrates eaten
  • Ages 0-7 yrs: 300/TDD
  • Ages ≥ 8 yrs: 400/TDD

Example Patient Calculations

Insulin Sensitivity Factor (Correction Factor)
  • Patient with TDD of insulin of 35 units
  • Correction factor = 1800 / 35 = 50
  • Thus, 1 unit of insulin will lower blood glucose by 50 points (1:50)
Correction Bolus Calculation
  • Patient current blood glucose is 300 mg/dL
  • Target blood glucose 100 mg/dL
  • 300 − 100 = 200
  • Divide 200 by correction factor 4
  • Correction bolus = (300 − 100) / 50 = 4
  • Correction bolus is 4 units
Ketone Dose Calculation
  • Patient blood glucose of 300 and BOHB > 1
  • TDD = 35 x 0.10 = 3.5 units
Giving the Dose
  • Administer the higher dose of ketone vs. correction
  • Give 4 units short-acting insulin