Ann Pharmacother

Subcutaneous insulin strategy appears effective for DKA management

May 21, 2025

Study details: The CRABI-DKA retrospective cohort study evaluated a protocol combining basal and rapid-acting subcutaneous (SC) insulin for managing diabetic ketoacidosis (DKA), aiming to reduce reliance on IV insulin and intensive care resources. The SC protocol used fixed doses of glargine and lispro at initiation, followed by lispro q3h, with labs and glucose checked q3h. The IV protocol involved a nurse-titrated insulin infusion, with hourly glucose and labs q2h.

Results: DKA resolved within 12 hours in 90% of patients in the SC group vs. 78% in the IV group (P = 0.1). Time to DKA resolution, as well as rates of hypoglycemia and hypokalemia, were similar between groups.

Clinical impact: The study supports use of a combination SC rapid-acting and basal insulin regimen as a viable alternative to IV insulin for mild to moderate DKA, potentially allowing management outside of intensive care settings with less frequent monitoring and similar safety and efficacy.

Source:

Ibarra F Jr, et al. (2025, May 20). Ann Pharmacother. Evaluation of an Alternative Approach to Managing Diabetic Ketoacidosis: Combination Rapid-Acting and Basal Subcutaneous Insulin (CRABI-DKA). https://pubmed.ncbi.nlm.nih.gov/40390456/