INS and diabetic ketoacidosis: Another study using SPA data to assess capacity to diagnose and manage diabetic ketoacidosis (DKA) in nine countries also found overall low availability of essential items, including insulin [16] In the DKA study, availability of essential items also varied greatly by country as well as facility level – for example, insulin availability ranged from 2% at secondary facilities in Bangladesh to 100% at tertiary ones in Malawi.