Review Question - QID 100339

This patient's presentation is consistent with diabetic ketoacidosis (DKA). Regular insulin is the most appropriate initial treatment for DKA.

DKA is a medical emergency that occurs in both type I and type II diabetics, although it is more common in type I. In DKA, insulin deficiency and glucagon excess promote hyperglycemia and ketogenesis, resulting in an anion gap metabolic acidosis, osmotic diuresis and volume depletion. Left untreated, the condition may progress to coma and death. Regular insulin is short-acting, especially when given intravenously, where its effect is almost immediate and the half-life is very short. For the initial treatment of DKA, regular insulin is given as an IV bolus and then as a continuous drip. Glargine is the longest acting insulin; it lasts 18-24 hours without a distinct peak in action with subcutaneous administration. Insulin lispro is the shortest acting insulin; it starts working in 15 minutes and peaks in 30 minutes to 1 hour when administered subcutaneously.

Incorrect Answers:
Answer 2 and 3 discussed above.
Answer 4: Dextrose would increase this patient's serum glucose and is not the appropriate initial step in the treatment of this patient. Note, however, that dextrose plays an important role later in DKA therapy by preventing hypoglycemia.
Answer 5: Glucagon would increase this patient's serum glucose and is contraindicated in DKA.