How should insulin be administered during the treatment of DKA in pregnancy?

In the management of diabetic ketoacidosis (DKA) during pregnancy, continuous intravenous (IV) infusion of insulin is the preferred method of administration. This approach allows for rapid and precise control of blood glucose levels, which is crucial in a DKA situation where both maternal and fetal safety are paramount.

The continuous infusion of insulin facilitates immediate adjustments based on regular monitoring of blood glucose and ketone levels, providing a steady state of medication that helps to quickly reverse the metabolic derangements characterizing DKA. This is particularly important in pregnancy, as fluctuations in blood sugar can adversely affect fetal well-being and increase the risk of complications.

Other routes of administration, such as bolus-only strategies or subcutaneous injections, may not provide the same level of control and can lead to delayed responses in correcting hyperglycemia. Inhalational insulin is not typically used in emergency settings like DKA, as it has not been shown to be effective for immediate treatment of such acute conditions. Therefore, continuous IV infusion is the most appropriate and effective method of insulin delivery during the treatment of DKA in pregnant patients.