Question

A 24-year-old woman with type 1 diabetes presents with nausea, vomiting and abdominal pain. She has been passing large volumes of urine and is very thirsty. Her capillary blood glucose is 27 mmol/L, ketones 4.8 mmol/L and venous bicarbonate 12 mmol/L. What is the most appropriate initial management step?

Accepted Answer

Start fixed-rate intravenous insulin infusion with fluid resuscitation and potassium monitoring

Answer

Give a large dose of subcutaneous rapid-acting insulin only

Answer

Withhold insulin until ketones clear, giving fluids alone

Answer

Start long-acting insulin only and arrange early review

Answer

Discharge with advice to increase her usual insulin doses

Practice question