I have extensive experience in the management of children with diabetic ketoacidosis (DKA). For the past 20 years, I have managed nearly 1,000 children admitted to the ICU in DKA, not including the 1000+ children admitted to the endocrine service for new-onset diabetes or established diabetics admitted to the hospital in mild acidosis. My training is in pediatric endocrinology, and I have spent time on the faculty at several university medical centers. I have given the resident and endocrine lectures on DKA management for the past 19 years across 3 pediatric academic centers. At the university pediatric hospital where I have worked for the past 14 years, our division cares for 100+ pediatric patients a year in the ICU. I have published an article on an algorithm that is used by many pediatric centers across the country and I have authored a book chapter on the treatment of DKA. Complications of excess fluid and/or insulin delivery include too rapid a drop in blood glucose level as well as a potential for development of cerebral edema. I have reviewed cases involving the development of cerebral edema resulting in the death of pediatric patients with either the diagnosis of new onset or established diabetes mellitus presenting in DKA. Delay in insulin treatment may result in DKA and death. In certain cases, a patient may develop cerebral edema after initiating therapy with fluid and insulin.