Diabetes mellitus (DM) is a chronic disease diagnosed in 20.9 million Americans; in addition, many people have undiagnosed DM.1  In 2011, the incidence of new diagnoses of DM was approximately 1.7 million and has increased every year since 1995.1  A severe acute metabolic complication of DM is diabetic ketoacidosis (DKA), which is listed as the primary diagnosis in approximately 7 patients with DM per 1000 hospital discharges and is associated with an average hospital length of stay of 3.4 days.1  Diabetic emergencies are twice as common in females.2  The annual expenditure for patients with DKA has been estimated at $2.4 billion.3 

Diabetic ketoacidosis is characterized by a decrease in effective insulin concentration and an increase in the concentration of counterregulatory hormones, including catecholamines, cortisol, glucagon, and growth hormone, which leads to the hallmark signs of DKA, such as anion gap metabolic acidosis, hyperglycemia, and elevated...

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