Question

A 25-year-old woman with type 1 diabetes presents with 24 hours of polyuria, vomiting and abdominal pain. On examination she is tachycardic and mildly drowsy. Capillary glucose is 27 mmol/L, venous pH 7.10 and serum ketones 6.0 mmol/L. Potassium is 4.8 mmol/L. After initial resuscitation with 1 L of 0.9% sodium chloride, what is the most appropriate next step in her management?

Accepted Answer

Start an intravenous insulin infusion at a fixed rate of 0.1 units/kg/hour

Answer

Give a single large intravenous bolus of insulin 10 units, then reassess in 6 hours

Answer

Delay insulin therapy until blood glucose falls below 15 mmol/L with fluids alone

Answer

Administer intravenous sodium bicarbonate routinely

Answer

Withhold insulin until potassium is <3.5 mmol/L

Practice question