Question

A 34-year-old with A1c 12.2%, pH 7.11, bicarbonate 9 mEq/L, anion gap 24, glucose 510 mg/dL, positive serum ketones. Initial insulin strategy?

Accepted Answer

Start IV regular insulin infusion 0.1 units/kg/hr after 0.1 units/kg IV bolus

Answer

Start insulin glargine 0.3 units/kg once

Answer

Start subcutaneous lispro 2 units hourly without fluids

Answer

Hold insulin until the anion gap closes with fluids alone

Answer

Give IV dextrose immediately before insulin

Practice question

A 34-year-old with A1c 12.2%, pH 7.11, bicarbonate 9 mEq/L, anion gap 24, glucose 510 mg/dL, positive serum ketones. Initial insulin strategy?