SummaryThe classical treatment of diabetic ketoacidosis, which permitted to decrease the mortality from 100 % before the discovery of insulin to±10 % in recent studies, was based on the administration of relatively large amounts of insulin, associated with the infusion of saline (or glucose) solution and of potassium chloride.Recently,«modern»schemes of insulin therapy including the administration of relatively small doses of insulin in order to reach physiological plasma insulin levels (20–200μU/ml) have been proposed. These schemes appear as efficient, easier to use routinely (because they are more systematic) and induce less secondary effects (especially hypoglycemia and hypokaliemia) than the classical schemes.The intravenous administration of insulin (either a continuous infusion or repeated hourly injections) seems more effective than the intramuscular route. When a continuous infusion is used, it is first necessary to neutralize the saline solution in which insulin is dissolved in order to avoid its precipitation and, thus, a decrease of its concentration in the solution. The dose of insulin administered must be sufficient and we proposed one of the following schemes: an initial intravenous injection of 20 U followed by a continuous infusion of 10–20 U/hourorhourly intravenous injections of 20 U of insulin until blood glucose reaches 250 mg/dl.This simple schememustof course be associated with an important and early rehydration (1 liter during the first hour and a total of 6–8 liters) and the administration of sufficient amounts of potassium(40mEq KCl/liter). Such treatment should be based on a careful clinical examination and on the survey of critical biological parameters made at the time of the admission of the patient as well as at regular intervals during the treatment. Special attention should also be given to the associated risk factors which increase the mortality rate.