Would anyone be willing to share how you facilitate appropriate transition to SUBQ insulin from IV insulin once DKA/HHS has resolved?

Do you incorporate your SUBQ transition orders (e.g. basal/bolus) into your DKA protocol/order set, or do you obtain the SUBQ orders once DKA has resolved (e.g. via individual MD orders or use of a separate transition order set)?

We include criteria for resolution of DKA/HHS in our DKA/HHS protocol, but it is then up to the nurse to contact the MD to stop the IV insulin and order SUBQ insulin. We are trying to encourage the administration of the first dose of SUBQ insulin (not just ordering Sliding Scale Insulin) prior to discontinuation of the drip.

Appreciate any information you can share if you have a good process in place!

Kind Regards,
Ronda Whipple PharmD
Medication Safety Specialist