Treatment of hyperglycaemic emergencies, 2004: The Pretoria approach

Abstract

The algorithm presented in this article is in use at the University of Pretoria academic hospitals. We have found that even though the guidelines as provided by the American Diabetes Association (ADA) are excellent, some detail such as intravenous (IV) and subcutaneous (SC) insulin adjustment are often lacking but are essential for busy ward staff and physicians in training. This protocol is aimed at treatment in the public sector and therefore does not address the use of insulin analogues in this setting. The ADA propose separate algorithms for diabetic ketoacidosis (DKA) and hyperosmolar non-ketotic coma (HONKC). We have combined this into one protocol for ease of use. This protocol is for adult patients as a different algorithm is needed for paediatric patients. In the algorithm Actrapid may be replaced by Humulin R. This algorithm could probably be used in community hospitals as well.