SGEM#511: I’d Like To Treat, DKA with the SQuID Protocol

Subcutaneous insulin serves as a safe, effective alternative to traditional intravenous insulin infusions for managing mild to moderate diabetic ketoacidosis (DKA) in stable, non-pregnant adults. While intravenous insulin remains the standard for severe cases, shock, or patients requiring intensive care, subcutaneous protocols offer a streamlined, less resource-intensive pathway. Retrospective analysis of a recent Canadian study reveals that although subcutaneous insulin may take longer to close the anion gap, it correlates with lower rates of hypoglycemia and hypokalemia. These outcomes are heavily influenced by local hospital infrastructure, nursing ratios, and patient demographics, particularly in older populations with type 2 diabetes. Successful implementation of subcutaneous protocols requires robust monitoring and standardized dosing, though the choice between administration routes remains nuanced rather than a simple clinical dichotomy.