INS and Hyperglycemia: This may account, in part, for the low proportion of subjects with DKA that is consistent with other reports, indicating that MDI use is associated with significantly higher rates of DKA in youth compared with traditional insulin pump use.3,6,21,25 However, the risk of DKA is still of concern as interruptions in insulin delivery and infusion site issues can quickly cause hyperglycemia, which can progress to DKA if untreated.25,33,41,42