Interactive diabetes case 1: Inpatient management in type 1 diabetes – B2

Answer — Correct.

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). The short-acting insulin was given to cover the pre-lunch hyperglycemia. The reduced dose of NPH compared with the home regimen was appropriate because of the delay in giving the morning NPH; the patient will need less NPH for the remainder of the day until her bedtime NPH dose, but enough to prevent recurrent hyperglycemia later in the day.

At 4:30 PM, the blood glucose level was 148 mg/dL (8.2 mmol/L). The patient did not eat most of her dinner and had her regular insulin before the meal.

At 7:00 PM, the patient became weak and diaphoretic. The blood glucose level by capillary finger stick was 48 mg/dL (2.7 mmol/L). The patient was treated with 8 ounces (240 mL) orange juice and several crackers.

At 10:00 PM, the blood glucose was 286 mg/dL (15.9 mmol/L). You order which of the following?

●Hold insulin because hyperglycemia reflects treatment of hypoglycemia. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – C1".)

●Hold NPH insulin and give regular insulin 4 units to cover hyperglycemia. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – C2".)

●Give NPH insulin 6 units (usual dose) and regular insulin 4 units. (See "Interactive diabetes case 1: Inpatient management in type 1 diabetes – C3".)