Diabetic ketoacidosis can be life-threatening but there’s some variability in the way it’s managed between health settings. Intervention involves intravenous insulin administration, hydration, electrolyte replacement and treatment of the underlying precipitant. In a survey of practitioners from 31 different hospitals in Australia there was an even split between those organisations which followed a fixed rate insulin infusion protocol, usually based on bodyweight, or a variable rate infusion protocol, titrated against blood glucose concentration. Three quarters of survey respondents had worked at another hospital that had different DKA management protocols raising concerns about the cognitive load on junior health staff moving between institutions. In Europe there has been some normalisation towards fixed rate protocols, despite there being no good quality evidence for superiority. In this podcast we hear some theories from two of the authors of the study published recently in the Internal Medicine Journal.12:40 SGLT2 inhbitor-associated ketoacidosis17:26 The cognitive burden of variation across settings25:11 the challenges of researching this questionsGuestsDr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney)Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital) Guest HostDr Mervyn Kyi FRACP PhD (Royal Melbourne Hospital; Northern Hospital)ProductionProduced by Dr Mervyn Kyi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Hugh Murray, Stephen Bacchi and Aafreen Khalid. Key Reference“Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey”  [IMJ. 2025]Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

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