Before initiating insulin therapy in suspected DKA, what parameter should be assessed?

• A. Potassium status
• B. Blood glucose level
• C. Blood pressure
• D. Serum magnesium

Answer: (A)

Potassium status is the key factor to check before starting insulin in suspected DKA. Insulin drives potassium from the bloodstream into cells, which can cause a dangerous drop in serum potassium if stores are already low. In DKA, total body potassium is usually depleted even when the blood potassium level looks normal or high because of dehydration and acidosis. If potassium is below roughly 3.3 mEq/L, insulin should be delayed and potassium repletion given first; once potassium is above that threshold, insulin can be started with ongoing potassium supplementation to keep levels safe. If potassium is in the normal to high range (about 3.3–5.0 mEq/L), you can begin insulin but must monitor and replace potassium to prevent a drop. If potassium is very high (above normal), you still start insulin but remain vigilant for shifts as therapy progresses. This approach prevents hypokalemia-related arrhythmias and supports safe correction of hyperglycemia and acidosis. Other factors like blood glucose level, blood pressure, and magnesium are important in management, but potassium status is the immediate gating parameter before insulin therapy.