Advanced Pharmacotherapy in Critical Care Online-How Sweet It Is: The Role of Early Subcutaneous Insulin in Treating DKA/HHS (Michelle Horng, PharmD, BCCCP, FCCM)

How Sweet It Is: The Role of Early Subcutaneous Insulin in Treating DKA/HHS (Michelle Horng, PharmD, BCCCP, FCCM)

Video Transcription

Video Summary

The video transcript discusses the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in terms of pathophysiology, presentation, diagnostic criteria, and management. HHS is less common but has a higher mortality rate than DKA, typically impacting older patients with type 2 diabetes. The treatment of HHS involves less aggressive fluid resuscitation and slower glucose lowering than DKA. The transcript also delves into the metabolic pathways involved in ketogenesis and the role of insulin in hyperglycemic emergencies. Studies on the use of subcutaneous insulin therapy and early initiation of long-acting insulin in DKA management are reviewed, with a focus on the benefits seen in terms of resolution time, ICU length of stay, and hospitalization cost. Resistance to change and challenges in implementing new protocols are also discussed, emphasizing the importance of effective communication, teamwork, and maintaining quality improvement initiatives over the long term. Finally, strategies for navigating external factors and ensuring project sustainability are highlighted, along with the crucial role of pharmacists in optimizing protocol adherence and patient outcomes.

Keywords

diabetic ketoacidosis

DKA

hyperosmolar hyperglycemic state

HHS

pathophysiology

management

insulin therapy

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