ADA/EASD/JBDS Consensus 2024 — Hyperglycemic Crises in Adults With Diabetes: A Consensus Report

For adult DKA and HHS, begin isotonic saline or balanced crystalloid with frequent reassessment, check potassium before insulin and delay insulin if potassium is below 3.5 mmol/L. Pure HHS without significant ketosis/acidosis generally uses lower-dose IV insulin after initial fluids, while mixed DKA/HHS follows the DKA insulin strategy; avoid overly rapid osmotic correction.