Long-acting insulin can be started during the intravenous treatment to ensure that there is a basal supply of insulin for when sub-cutaneous therapy is formally started.
By the afternoon of the next day Jessica's dehydration is improving, her pH is almost normal and her sugars are in an acceptable range. She commences subcutaneous insulin with her evening meal 24 hours after she presented in DKA.
She and her mother receive intensive training from the diabetes team and she is discharged one day later.
Teacher's Comment
Interestingly Jessica was found to have a Haemoglobin variant (Sickle Cell Trait) and, as this affects Red Cell half-life, it can lead to a falsely low HbA1c level due to increased cell turnover.