Hyperkalaemia, ketoacidosis and subcutaneous or intravenous insulin infusions

We report a case of a previously stable Type 1 insulin-dependent diabetic who developed diabetic ketoacidosis with marked hyperkalaemia after starting continuous subcutaneous insulin infusion for neuropathy. On two occasions during his hospital admissions he had a rapid onset of hyperkalaemia after short interruptions to this intravenous insulin infusion. Hyperkalaemia can occur rapidly in patients who are treated with short acting insulin only.