Editing Diabetic ketoacidosis (section)

===Insulin===
Some guidelines recommend a bolus (initial large dose) of insulin of 0.1&nbsp;units of insulin per kilogram of body weight. This can be administered immediately after the potassium level is known to be higher than 3.3&nbsp;mmol/L; if the level is any lower, administering insulin could lead to a dangerously low potassium level (see below).<ref name=ADA2009/> Other guidelines recommend a bolus given intramuscularly if there is a delay in commencing an intravenous infusion of insulin,<ref name=JBDS/> whereas guidelines for the management of pediatric DKA recommend delaying the initiation of insulin until fluids have been administered.<ref name=BSPED/> It is possible to use rapid acting [[insulin analog]]s [[Subcutaneous injection|injections under the skin]] for mild or moderate cases.<ref>{{cite journal | vauthors = Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Gonzalez-Padilla DA | title = Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD011281 | date = January 2016 | pmid = 26798030 | pmc = 8829395 | doi = 10.1002/14651858.CD011281.pub2 }}</ref>

In general, insulin is given at 0.1&nbsp;units/kg per hour to reduce blood sugars and suppress ketone production. Guidelines differ as to which dose to use when blood sugar levels start falling; American guidelines recommend reducing the dose of insulin once glucose falls below 16.6&nbsp;mmol/L (300&nbsp;mg/dL)<ref name=ADA2009/> and UK guidelines at 14&nbsp;mmol/L (253&nbsp;mg/dL).<ref name=JBDS/> Others recommend infusing glucose in addition to saline to allow for ongoing infusion of higher doses of insulin.<ref name=NICE2015/><ref name=BSPED/>