Diabetes Education Certification Acute Complications Management 2 — Questions and Answers
Question 1: A patient with type 1 diabetes is found unresponsive with a blood glucose of 28 mg/dL. No IV access is available. What is the most appropriate initial intervention?
- Administer oral glucose gel
- Administer glucagon 1 mg IM or subcutaneously (Correct answer)
- Wait for EMS to establish IV access
- Place the patient in Trendelenburg position
Correct answer: Administer glucagon 1 mg IM or subcutaneously
Glucagon IM or subcutaneous injection is the preferred treatment for severe hypoglycemia when IV access is unavailable and the patient cannot safely swallow.
Question 2: Which acid-base disturbance is characteristic of diabetic ketoacidosis (DKA)?
- Metabolic alkalosis with respiratory compensation
- Respiratory acidosis with metabolic compensation
- High anion gap metabolic acidosis (Correct answer)
- Hyperchloremic non-anion gap metabolic acidosis
Correct answer: High anion gap metabolic acidosis
DKA produces a high anion gap metabolic acidosis due to accumulation of ketoacid anions (beta-hydroxybutyrate and acetoacetate).
Question 3: A patient with type 2 diabetes on metformin develops HHS with a serum osmolality of 340 mOsm/kg. What is the priority fluid for initial resuscitation?
- 0.45% normal saline
- D5W
- 0.9% normal saline (isotonic saline) (Correct answer)
- Lactated Ringer's solution
Correct answer: 0.9% normal saline (isotonic saline)
Isotonic saline (0.9% NaCl) is administered first to restore circulating volume before switching to hypotonic fluids once hemodynamic stability is achieved.
Question 4: A patient using an insulin pump is found with blood glucose of 550 mg/dL and ketones present. The pump site appears red and swollen. What is the most likely cause?
- Insulin resistance from infection
- Lipohypertrophy at the site
- Pump site failure causing insulin non-delivery (Correct answer)
- Dawn phenomenon
Correct answer: Pump site failure causing insulin non-delivery
An inflamed or occluded pump site prevents insulin delivery, rapidly leading to ketosis in type 1 diabetes because there is no basal insulin reserve.
Question 5: When treating DKA, at what serum glucose level should dextrose be added to the IV fluids while continuing insulin?
- When glucose drops below 400 mg/dL
- When glucose drops below 250 mg/dL (Correct answer)
- When glucose drops below 150 mg/dL
- Only after anion gap closes completely
Correct answer: When glucose drops below 250 mg/dL
Dextrose is added to IV fluids when glucose falls below 250 mg/dL to allow continued insulin infusion needed to resolve ketoacidosis.
Question 6: A patient recovering from DKA asks why potassium was given even though their initial serum potassium was 5.1 mEq/L. What is the best explanation?
- Total body potassium is depleted despite initially normal or elevated serum levels (Correct answer)
- Insulin causes renal potassium wasting
- Acidosis permanently elevates intracellular potassium
- Potassium prevents cerebral edema during rehydration
Correct answer: Total body potassium is depleted despite initially normal or elevated serum levels
In DKA, total body potassium is depleted; initial hyperkalemia is artifactual due to acidosis-driven potassium shift out of cells, which reverses with insulin and fluid treatment.
Question 7: Which of the following clinical findings most distinguishes HHS from DKA?
- Presence of polyuria and polydipsia
- Severe dehydration and altered mental status without significant ketosis (Correct answer)
- Elevated blood glucose above 250 mg/dL
- Tachycardia and hypotension
Correct answer: Severe dehydration and altered mental status without significant ketosis
HHS is characterized by extreme hyperglycemia (often >600 mg/dL), severe dehydration, and altered consciousness with absent or minimal ketosis, unlike DKA.
Diabetes Education Certification Acute Complications Management 2
A patient with type 1 diabetes is found unresponsive with a blood glucose of 28 mg/dL.
No IV access is available.
What is the most appropriate initial intervention?