Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic

G. Rayman, A. Lumb, B. Kennon, C. Cottrell, D. Nagi, E. Page, D. Voigt, H. Courtney, H. Atkins, J. Platts, K. Higgins, K. Dhatariya, M. Patel, P. Narendran, P. Kar, P. Newland-Jones, R. Stewart, O. Burr, S. Thomas

Research output: Contribution to journalLetterpeer-review

16 Citations (Scopus)


During the early stages of the COVID-19 pandemic, hospitals in London, the UK epicentre, reported an unusually high number of people presenting with COVID-19 disease developing diabetic ketoacidosis, hyperosmolar hyperglycaemic state, or a combination of both. Very high doses of insulin were often needed to manage the hyperglycaemia. It has been proposed that these metabolic disturbances may result from severe insulin resistance combined with decreased insulin secretion due to beta cell dysfunction [1]. The increased demand for pumps to deliver inotropes has led to concerns of possible shortages of infusion pumps and/or 50 ml syringes being available for insulin infusions to manage these hyperglycaemic emergencies. Concerns were also raised about the potential risk of exacerbating ‘lung leak’ in COVID-19 positive patients using the traditional rates of fluid replacement for the management of DKA. Clinicians therefore requested that a subcutaneous insulin regimen be made available as a backup strategy for managing diabetic ketoacidosis and guidance on the fluid replacement regimen.
Original languageEnglish
Pages (from-to)1214-1216
Number of pages3
JournalDiabetic Medicine
Issue number7
Early online date18 May 2020
Publication statusPublished - 1 Jul 2020

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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