Interactive diabetes case 1: Inpatient management in type 1 diabetes – C1

ANSWER — Incorrect.

By 6:30 AM the next day, the fasting blood glucose level was 577 mg/dL (32 mmol/L), sodium 130 mEq/L, potassium 5.2 mEq/L, carbon dioxide (CO₂) content 15 mEq/L, and chloride 95 mEq/L. The serum beta-hydroxybutyrate level was 4.9 mmol/L (normal range less than 0.6 mmol/L, diabetic ketoacidosis [DKA] 3 mmol/L or above). The patient is in DKA.

This patient with type 1 diabetes had received no basal (intermediate or long-acting) insulin since 11:00 AM on the first full hospital day (and a reduced dose at that time). Omission of the intermediate-acting insulin (NPH) in the evening resulted in severe insulin deficiency.

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 – B2".)