A 40-year-old man with type 1 diabetes presents with vomiting, pH 7.1, glucose 28 mmol/L and ketones 5.5 mmol/L. Which insulin approach do UK guidelines recommend?

Answer and explanation

Correct answer: B. Fixed-rate IV insulin at 0.1 units per kg per hour

  1. Step 1: This is DKA.
  2. Step 2: The Joint British Diabetes Societies recommend fixed-rate IV insulin 0.1 units/kg/h, long-acting insulin continued, and glucose added when it falls.
Answer
Fixed-rate IV insulin at 0.1 units per kg per hour.
Why not the others: Intravenous bicarbonate alone, with insulin withheld until the pH reaches 7.3: Bicarbonate is not routine and insulin is the key treatment. Subcutaneous soluble insulin 20 units, with all long-acting insulin stopped: Subcutaneous insulin is too slow and stopping basal insulin worsens control. A variable sliding-scale infusion, stopped once glucose falls below 15 mmol/L: Variable scale is the older method, and stopping at 15 would not clear ketones.

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