Therapy goals
- Slow normalization of blood glucose (BG).
- Balancing the water and acid-base balance
- Balancing the electrolytes (blood salts)
Therapy recommendations
- Diabetic ketoacidosis (DKA; synonym: ketoacidotic coma) is primarily corrected by insulin, fluid, and potassium administration
- Hyperosmolar nonketotic coma or syndrome (HNKS; synonyms: hyperosmolar diabetic coma; hyperglycemic coma) is treated by administration of saline and insulin and potassium.
- See also under “Other therapy.”
Active substances (main indication)
| Active ingredient group | Active ingredients | Special features |
| Full electrolyte solution | NaCl solution 0.9 |
DKA: typically a minimum of 3 L of saline in the first 5 hours.
See above under “Additional notes.” |
| Ringer’s solution (isotonic electrolyte solution for intravenous infusion) | ||
| Insulin | Normal insulin | No insulin therapy without volume administration In HNKS: insulin is administered only after the first liter of saline has been given |
| Hypotonic solution | Glucose 5 % | Do not pause insulin because of lipolysis |
| Electrolytes | Potassium | From insulin therapy, when BG decreases |
| Phosphate | Consider with serum phosphate <0.5 mmol/l KI (not) in renal insufficiency/renal impairment |