• Brian W Gilbert, Danielle S Murray, Tessa R Cox, Joanna He, Audrey M Wenski, and Kathryn E Qualls.
• Emergency Medicine Clinical Pharmacy Specialist, Residency Program Director, PGY-2 Critical Care Pharmacy, Department of Pharmacy, Wesley Medical Center, 550 N. Hillside Street, Wichita, KS, 67214, United States of America. Electronic address: Brian.gilbert.pharmd@gmail.com.
• Am J Emerg Med. 2023 Oct 1; 72: 147150147-150.

AbstractDiabetic ketoacidosis (DKA) remains a significant challenge for healthcare systems due to prolonged lengths of stay and rising costs. The current American Diabetes Association (ADA) guidelines recommend starting basal insulin after resolution of DKA. However, these guidelines have not been updated since 2009, which can potentially limit optimal care. Meanwhile, the Joint British Society guidelines on DKA management, which were more recently updated in March 2023, do advocate for early administration of basal insulin in their treatment algorithm. This article assesses the rationale and literature associated with the recommendation for early basal insulin administration in the management of DKA. Benefits of early basal insulin in this cohort appears to be associated with less rebound hyperglycemia, reduction in time to DKA resolution, reduced intravenous insulin requirements, and reduced length of stay without associated increases in hypoglycemic or hypokalemic events.Copyright © 2023 Elsevier Inc. All rights reserved.

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