Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings: role of subcutaneous insulin.

The International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state 1, 2 provide comprehensive guidance for management of DKA in young people (Figure 1). Intravenous (IV) infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit (ICU) for IV insulin infusion. During the coronavirus 2019 (COVID-19) pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritised or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD 2018 guidelines1 , is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources. Specifically, this guideline summarises evidence for the role of subcutaneous (SC) insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option. The levels of evidence follow the American Diabetes Association (ADA) evidence-grading system for 'Standards of Medical Care in Diabetes' and are presented in Table 2.3 This article is protected by copyright. All rights reserved.