Question

A 72-year-old woman with poorly controlled type 2 diabetes (HbA1c 12%) presents drowsy and dehydrated with a 3-day history of lethargy and polyuria. Capillary glucose is 40 mmol/L. Venous pH is 7.36, bicarbonate 22 mmol/L and serum ketones are 0.5 mmol/L. Serum osmolality is elevated. What is the most appropriate first step in her management?

Accepted Answer

Aggressive intravenous fluid resuscitation with isotonic saline and gradual insulin infusion

Answer

Rapid intravenous insulin bolus followed by high-dose insulin infusion without fluids

Answer

Oral rehydration and increase in oral hypoglycaemic medications

Answer

Immediate bicarbonate infusion

Answer

Subcutaneous rapid-acting insulin only

Practice question