Treatment options for DKA in Thailand

A SIMPLIFIED THREE-LINE INTRAVENOUS INSULIN PROTOCOL FOR CRITICAL CARE

MANAGEMENT OF FELINE DIABETES

Nonsee Rodmanee1,*, Sukullaya Rilhikulprasert

Department of Small Domes@c Animal and Radiology, Faculty of Veterinary Medicine, Mahanakorn University of Technology, Bangkok 10530, Thailand; 2Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand

Intravenous (IV) regular insulin protocols are used in critically ill diabeticc cats, especially those with diabetic ketoacidosis. Conventional protocols typically require insulin dilution, infusion rate adjustments, and modifications of IV fluid composition based on standardized charts. However, repeated fluid changes can be cumbersome and may increase the risk of contamination. The proposed regular insulin protocol utilizes a system with one IV access, in which normal saline solution (NSS) serves as the primary line and is connected to a diluted insulin solution and 5% dextrose in water (D5W) via two 3-way stopcocks. Initially, diluted insulin is prepared by adding 8 U of regular insulin to 100 mL of NSS. When blood glucose (BG) is >250 mg/dL, NSS and diluted insulin are administered at 30 mL/kg/day, providing an approximate dose of 0.1 U/kg/h. As BG decreases to 150–250 mg/dL, insulin is reduced to 20–25 mL/kg/h and D5W is added, resulting in an overall fluid composition equivalent to 2.5D1/2NSS. At BG 100–150 mg/dL, D5W is further increased and insulin is reduced to 15 mL/kg/day (approximately 0.05 U/kg/h). When BG is <100 mg/dL, only D5W is administered. This protocol was successfully applied in a diabetic cat with unconsciousness and neurological signs, achieving target BG control (100–250 mg/dL), particularly with continuous glucose monitoring. This simplified protocol provides advantages, including easy dose management, reduced fluid bag changes, lower contamination risk, improved workflow efficiency, and potential cost reduction for owners.