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Insulin pump failure with ketosis — SCE Endocrinology MCQ

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HardDiabetes mellitusInsulin pump failure with ketosisSCE Endocrinology

A 45-year-old woman with type 1 diabetes uses an insulin pump. She presents with nausea and malaise; glucose is 18 mmol/L and blood ketones are 2.8 mmol/L. The cannula site is inflamed and pump delivery history suggests occlusion. Venous pH is 7.31. What is the most appropriate management?

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Correct answer: E — Give rapid-acting insulin by injection, change the infusion set and follow ketone sick-day rules

Give rapid-acting insulin by injection, change the infusion set and follow ketone sick-day rules is best because pump users have no long-acting insulin depot, so delivery failure can rapidly cause ketosis and requires injected insulin plus set change. The alternatives are less appropriate because a bolus through the failed cannula may not deliver; waiting for worse acidosis risks DKA; stopping insulin is unsafe; fluids alone will not clear ketones. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG17; JBDS-IP DKA guideline