The practice of delaying the change from intravenous insulin infusion to subcutaneous insulin administration until the calculated difference between certain electrolytes in the blood normalizes is a critical aspect of managing diabetic ketoacidosis (DKA). This difference, known as the anion gap, reflects the accumulation of acidic ketones in the bloodstream. Premature transition to subcutaneous insulin can lead to rebound ketoacidosis, hindering recovery and potentially prolonging the hospital stay. For instance, if the anion gap remains elevated, indicating ongoing acid production, subcutaneous insulin might not be absorbed quickly enough to effectively suppress ketogenesis.
Adhering to this principle ensures that the underlying metabolic derangement of DKA is adequately resolved before relying on longer-acting insulin formulations. This approach minimizes the risk of recurrent acidosis and allows for a more predictable and controlled transition. Historically, early transitions to subcutaneous insulin, driven by factors such as perceived efficiency or patient convenience, resulted in increased rates of relapse. The current best practice, therefore, emphasizes biochemical resolution as a primary endpoint before initiating subcutaneous insulin.
