Brigham and Women's Hospitals


Updated May 1, 2020


  1. This section is in development

ICU Management of Hyperglycemia and Diabetic Ketoacidosis

  1. Hyperglycemia, DKA with concomitant increased insulin requirements are common in critically ill patients with COVID-19.
  2. In an effort to minimize the number of patients on insulin infusions, the Diabetes Subcommittee has developed a guideline for COVID-19 patients who are critically ill and/or in mild-moderate DKA to allow for q 4h monitoring and SC insulin dosing.
  1. This strategy will minimize exposure with RN time at bedside and conserve PPE while maintaining the ability to deliver high dose insulin therapy distributed across multiple adjustable doses per day.
  2. The major difference to highlight is the change to a q 4h interval (as compared to the q 1h monitoring and insulin dosing with BHIP and q 2h with the SC DKA protocol). This guideline also expands the use of a SC DKA protocol to include both mild and moderate DKA and with this in place only severe DKA/HHS will require an insulin infusion.
  1. Guidelines on COVID-specific DKA and Hyperglycemia Insulin treatment are available here
  2. Additional glucose and insulin management assistance is available by paging Endocrine (p11519) or Diabetes (p34444) Consultation. They can assist with:
  1. Adjustment of Insulin Orders and Hypoglycemia Prevention
  2. Insulin Management during Transition of Care Planning


  1. This section is in development

Adrenal Insufficiency

  1. This section is in development