Reflecting current thought in the ICU where I work...as for “ hyper glycemic keto acidosis” I mention it here because while some are just extremely negligent and put themselves into it, others are brittle or illness, especially viral or bacterial infections can trigger it even in persons whose diabetic conditions are well controlled. Any sort of steroid use(auto immune or for pulmonary or upper airway disease, can cause an increase of glucose, triggering a need for more of a basal level of insulin.