???? REBEL Rundown ????️ Key Points

• ????️ Fewer ICU Admissions
  Only 5 patients in the SQuID group required ICU care vs 99 in the traditional insulin drip group.
• ⏱️ Shorter ED Stays
  ED length of stay dropped by ~3 hours in the SQuID group—an operational win in crowded departments.
• ???? No Drop in Nursing Workload
  Despite using subQ insulin, nurses still performed hourly glucose checks and frequent injections.
• ???? Focus on the Anion Gap
  DKA resolution = closing the anion gap, not just normalizing blood sugar—critical concept for trainees and nurses alike.
• ???? Peds Has the Edge
  Pediatric ICUs routinely use a 2-bag system (D10 + electrolytes vs electrolytes alone) to safely continue insulin while managing glucose—adult medicine should take note.

Click here for Direct Download of the Podcast.

???? Introduction

In this episode of REBEL Cast, we dive into part one of our Diabetic Ketoacidosis (DKA) series with a twist—subcutaneous insulin instead of the traditional IV drip. We explore the SQuID Protocol (Subcutaneous Insulin in DKA), which could potentially shift how we manage mild to moderate DKA—from the ICU to the general floor.

With ICU bed shortages, ED boarding, and nursing resource challenges, it’s time to ask: Do all DKA patients really need a drip and an ICU bed?

We reviewed a quasi-experimental study comparing traditional insulin drips versus subcutaneous insulin (lispro q4h + glargine at time zero) in a busy urban ED. The results? Promising—but not without caveats.

???? SQuID Protocol

???? Clinical Bottom Line

The SQuID Protocol appears safe and effective for carefully selected patients with mild to moderate DKA. It may reduce ICU admissions and shorten ED stays. But implementation requires thoughtful coordination, nursing comfort, and institutional buy-in. This isn’t ready for prime time everywhere—but it’s worth knowing and considering when ICU resources are tight.

Post Peer Reviewed By: Marco Propersi (Twitter/X: @Marco_propersi), and Kim Bambach, MD

Show Notes By: Mark Ramzy, DO

Authors Mark Ramzy, DO Co-Editor-in-Chief RWJBH / Rutgers Health, Newark, NJ Frank Lodeserto Associate Editor Cape Fear Valley Medical Center, Fayetteville NC ???? Your Deep-Dive Starts Here REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol

Mechanical ventilation can feel overwhelming, especially when faced with a ...

Endocrine, Metabolic, Fluid, and Electrolytes Read More REBEL Core Cast 18.0 – DKA Tips and Tricks

Take Home Points When looking at pH and bicarb, the ...

Endocrine, Metabolic, Fluid, and Electrolytes Read More

The post REBEL Core Cast – DKA: Beyond the Basics Part 1 – The SQuID Protocol appeared first on REBEL EM - Emergency Medicine Blog.