Interactive diabetes case 1: Inpatient management in type 1 diabetes – B3

ANSWER — 

Incorrect.

The serum beta-hydroxybutyrate level was 0.4 mmol/L (normal range less than 0.6 mmol/L, diabetic ketoacidosis [DKA] 3 mmol/L or above).

At 4:30 PM, the blood glucose level was 186 mg/dL (10.3 mmol/L), so no insulin was given by the sliding scale. At 10:00 PM, the blood glucose level was 249 mg/dL (13.8 mmol/L), so the patient received 4 units of regular insulin by sliding scale.

At 6:30 AM the next day, the fingerstick blood glucose level was 397 mg/dL (22 mmol/L). Blood was sent to the chemistry laboratory stat with the following results: blood glucose 411 mg/dL (22.8 mmol/L), sodium 133 mEq/L, potassium 4.9 mEq/L, carbon dioxide (CO₂) 18 mEq/L, chloride 99 mEq/L, and serum beta-hydroxybutyrate level 3.6 mmol/L. The patient is now in DKA.

The patient has type 1 diabetes and has not received NPH insulin for more than 24 hours. The NPH insulin should not have been omitted.

The use of a sliding scale insulin regimen as the sole treatment of hyperglycemia in inpatients with insulin-treated diabetes at home is strongly discouraged [1].

Patients with type 1 diabetes need a basal (intermediate or long-acting) insulin at all times to prevent DKA. The basal insulin should not be withheld when a patient with type 1 diabetes is in the hospital (unless the patient will receive a continuous infusion of intravenous insulin). If the patient is unable to eat, prandial doses of a short- or very short-acting insulin may be omitted, and intravenous glucose should be provided to prevent hypoglycemia until the patient is able to eat a full meal. (See "Management of diabetes mellitus in hospitalized patients".)

Return to the previous choice to try again. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – A1".)