VETINUITY
When do you start the insulin CRI?
After the first hours of fluid therapy have restored perfusion, commonly 2 to 6 hours in, and once serum potassium is at least in the low-normal range, because insulin drives potassium into cells.
● ANSWER
Sourced & dated
How do you run an insulin CRI for a dog with DKA?
Vetinuity's canine DKA table: add 2.2 U/kg regular insulin to 250 mL 0.9% NaCl, start at 10 mL/h, and step the rate and dextrose down as glucose falls.
● VETINUITY CANINE DKA DOSE CALCULATOR
Vetinuity canine DKA dose calculator
Insulin goes into 250 mL of 0.9% NaCl; run 50 mL through the line before connecting, because insulin binds the tubing.
● WHAT'S DOCUMENTED
Vetinuity’s canine DKA insulin table: add regular insulin at 2.2 U/kg to 250 mL of 0.9% NaCl, start the infusion at 10 mL/h once the dog is rehydrating and potassium is supported, then slow the rate and add dextrose as blood glucose falls, aiming for a drop of 50 to 75 mg/dL per hour. The Vetinuity canine DKA dose calculator above gives the units for the bag, the phosphate rate and the first fluid bolus for the dog’s weight. Vetinuity is the clinical assistant built by Brian Toncray, DVM, an emergency veterinarian.
Rate steps by blood glucose
Check glucose every 1 to 2 hours and adjust the insulin line against this table, a version of the low-dose infusion Macintire described in dogs:
| Blood glucose (mg/dL) | Insulin bag rate | Fluids |
|---|---|---|
| Over 250 | 10 mL/h | 0.9% NaCl |
| 200 to 250 | 7 mL/h | 0.45% NaCl with 2.5% dextrose |
| 150 to 200 | 5 mL/h | 0.45% NaCl with 2.5% dextrose |
| 100 to 150 | 5 mL/h | 0.45% NaCl with 5% dextrose |
| Under 100 | Stop | 0.45% NaCl with 5% dextrose |
The insulin bag runs on its own pump, separate from the maintenance and replacement fluids, so each can be changed without touching the other.
Potassium, phosphate and the first hours
Total body potassium is depleted even when the first serum value looks normal, and insulin will drop it further. Supplement potassium chloride by the measured value and never exceed 0.5 mEq/kg/h. Phosphorus falls in the first 24 hours of treatment; below about 1.5 mg/dL, hemolysis becomes a risk, and potassium phosphate at 0.01 to 0.03 mmol/kg/h corrects it (count its potassium in the total). Recheck electrolytes every 4 to 8 hours early on.
What else the dog needs
Look for the trigger: pancreatitis, urinary tract infection, hyperadrenocorticism and other concurrent disease drive most canine DKA. Rehydrate over 12 to 24 hours after perfusion is restored, correcting sodium slowly. Switch to subcutaneous insulin when the dog is eating, ketones are falling and glucose is controlled. The insulin CRI calculator works out bag and rate math for other concentrations.
Related: feline DKA, pancreatitis, shock fluid bolus and sodium correction.
● SOURCES
- 1. Macintire DK. Treatment of diabetic ketoacidosis in dogs by continuous low-dose intravenous infusion of insulin. J Am Vet Med Assoc. 1993;202(8):1266-1272. PMID 8496083. Abstract. Checked 2026-10-26.
- 2. Merck Veterinary Manual: Diabetes Mellitus in Dogs and Cats. Diabetic ketoacidosis; Treatment. Checked 2026-10-26.
● RELATED ANSWERS
- Feline DKA: Insulin, Fluids and Monitoring
Feline DKA treatment combines insulin with fluid therapy, electrolyte correction and investigation of the underlying disease; insulin addresses ketosis as well as hyperglycemia.
- Hyponatremia in Dogs: Sodium Correction
Rapid correction of chronic hyponatremia risks osmotic demyelination; sodium replacement requires a measured correction strategy and repeated concentration checks.
- Canine Acute Pancreatitis: Management
Canine acute pancreatitis care centers on fluid support, analgesia, antiemetics and nutrition, with treatment adjusted to severity and complications.
- Shock Fluid Bolus Volumes for Dogs and Cats
Vetinuity's shock bolus table: isotonic crystalloid 10-20 mL/kg over 15-30 minutes in dogs and 5-10 mL/kg in cats, reassessed after each, or 7.5% hypertonic saline at 3-5 mL/kg in dogs.
- Addisonian Crisis in Dogs: Emergency Treatment
Addisonian crisis requires emergency stabilization with IV fluids, close monitoring and replacement of deficient glucocorticoid support, tailored to the dog’s abnormalities.
● FAQ
How fast should blood glucose fall?
About 50 to 75 mg/dL per hour. Faster drops shift water into the brain and are the reason the rate table steps down and adds dextrose.
Is the cat protocol the same?
Cats use half the insulin in the bag, 1.1 U/kg in 250 mL, with the same glucose-based rate steps.
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