How often should blood glucose be checked after starting IV insulin in DKA?

• A. Every hour until stable, then every 2-4 hours depending on protocol.
• B. Every 6 hours.
• C. Only once per day.
• D. Every 15 minutes.

Answer: (A)

When IV insulin is started in DKA, glucose needs to be checked frequently because insulin can rapidly drive glucose downward and shift potassium into cells. Checking glucose every hour allows you to detect a fast drop and adjust the insulin rate or add dextrose promptly, preventing hypoglycemia while still controlling hyperglycemia. As the patient stabilizes and glucose nears the target range (often around 150–200 mg/dL) and the metabolic parameters improve, the checks can be spaced out to about every 2–4 hours, depending on protocol.

Checks every 6 hours or only once per day don’t capture the rapid changes that occur with IV insulin, risking unsafe drops or persistent hyperglycemia. Checking every 15 minutes is unnecessarily frequent once stability is achieved and is not the standard practice.