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Insulin prescribing safety — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePatient Safety and Risk ManagementInsulin prescribing safetySCE Acute Medicine

A 72-year-old man with type 1 diabetes is admitted with cellulitis and reduced oral intake. His long-acting insulin is omitted overnight because he is not eating. The next morning he is nauseated, glucose is 22 mmol/L and ketones are 3.6 mmol/L. What is the most likely underlying cause?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Omission of basal insulin causing ketosis

People with type 1 diabetes require basal insulin even when not eating; omission can rapidly cause ketosis and DKA. Reduced oral intake usually requires adjustment, not stopping basal insulin. Metformin toxicity would not explain ketonaemia from insulin deficiency. The pearl is that basal insulin is a time-critical inpatient medicine.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-82-1