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Sick-day ketosis in type 1 diabetes — SCE Endocrinology MCQ

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HardDiabetesSick-day ketosis in type 1 diabetesSCE Endocrinology

A 35-year-old man with type 1 diabetes has vomiting after a viral illness. Glucose is 13 mmol/L, ketones 3.4 mmol/L and bicarbonate is 20 mmol/L. He has continued basal insulin but omitted rapid-acting insulin because he has not eaten. What is the underlying pathophysiology?

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Correct answer: B — Insulin deficiency permits lipolysis and hepatic ketogenesis despite modest glucose

Sick-day ketosis occurs because insulin is needed to suppress lipolysis and ketogenesis even when oral intake is poor. Modest glucose does not exclude clinically important ketosis. The teaching point is to continue basal insulin and use corrective rapid-acting insulin with ketone monitoring during illness.

Reference: NICE NG17, JBDS DKA guideline