Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?

J Emerg Med. 2015 Oct;49(4):530-8. doi: 10.1016/j.jemermed.2015.05.016. Epub 2015 Jul 31.


Background: In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes.

Clinical question: In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?

Evidence review: Five randomized controlled trials were identified and critically appraised.

Results: The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.

Conclusion: Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.

Keywords: DKA; diabetic ketoacidosis; hospitalization; insulin; intensive care.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Diabetic Ketoacidosis / drug therapy*
  • Emergency Medicine / methods
  • Emergency Service, Hospital / statistics & numerical data*
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Injections, Subcutaneous
  • Insulin, Short-Acting / administration & dosage*
  • Length of Stay
  • Male
  • Patient Admission / statistics & numerical data*
  • Randomized Controlled Trials as Topic
  • Young Adult


  • Hypoglycemic Agents
  • Insulin, Short-Acting