Diabetes Education Certification Acute Complications Management 3 — Questions and Answers
Question 1: A 17-year-old with new-onset type 1 diabetes presents with Kussmaul breathing, fruity breath odor, and glucose of 480 mg/dL. Which finding best confirms DKA over hyperglycemia alone?
- Blood glucose above 250 mg/dL
- Bicarbonate less than 18 mEq/L with ketonemia (Correct answer)
- Heart rate of 110 bpm
- Urine glucose 4+
Correct answer: Bicarbonate less than 18 mEq/L with ketonemia
DKA is confirmed by the triad of hyperglycemia, ketonemia/ketonuria, and metabolic acidosis (bicarbonate <18 mEq/L or pH <7.3).
Question 2: A patient with diabetes develops hypoglycemia unawareness. Which statement about this condition is correct?
- It is caused by peripheral neuropathy blocking pain perception
- Repeated hypoglycemic episodes blunt epinephrine and glucagon counter-regulatory responses (Correct answer)
- It only occurs in patients using insulin pumps
- It can be reversed by increasing the insulin dose
Correct answer: Repeated hypoglycemic episodes blunt epinephrine and glucagon counter-regulatory responses
Hypoglycemia unawareness results from impaired counter-regulatory hormone responses (epinephrine, glucagon) due to antecedent hypoglycemic episodes, reducing warning symptoms.
Question 3: A nurse administers glucagon to a patient with severe hypoglycemia. After 15 minutes the patient regains consciousness. What should be done next?
- Administer a second dose of glucagon
- Provide oral carbohydrates and a protein-containing snack (Correct answer)
- Start an insulin infusion immediately
- Recheck glucose in 2 hours without further intervention
Correct answer: Provide oral carbohydrates and a protein-containing snack
After glucagon administration restores consciousness, oral carbohydrates and protein prevent rebound hypoglycemia because glucagon's effect is temporary.
Question 4: Which electrolyte abnormality during DKA treatment requires continuous cardiac monitoring?
- Hyponatremia
- Hypokalemia (Correct answer)
- Hypomagnesemia
- Hypophosphatemia
Correct answer: Hypokalemia
Hypokalemia, which can worsen rapidly with insulin therapy, can cause life-threatening arrhythmias requiring continuous cardiac monitoring during DKA treatment.
Question 5: A patient with type 2 diabetes on a sulfonylurea develops hypoglycemia. Why is prolonged monitoring especially important in this case?
- Sulfonylureas cause irreversible beta-cell damage
- Sulfonylureas have long half-lives and can cause recurrent hypoglycemia for 24–72 hours (Correct answer)
- Sulfonylureas block glucagon secretion permanently
- Hypoglycemia is always more severe with sulfonylureas than with insulin
Correct answer: Sulfonylureas have long half-lives and can cause recurrent hypoglycemia for 24–72 hours
Sulfonylureas stimulate insulin secretion for extended periods; hypoglycemia can recur many hours after initial treatment due to their long duration of action.
Question 6: Which of the following patients with DKA is at highest risk for cerebral edema as a complication of treatment?
- 65-year-old with type 2 diabetes and HbA1c of 9%
- 45-year-old with DKA secondary to infection
- 12-year-old child with new-onset type 1 diabetes (Correct answer)
- Adult with known DKA history treated 3 times previously
Correct answer: 12-year-old child with new-onset type 1 diabetes
Children, especially those with new-onset type 1 diabetes, are at significantly higher risk for cerebral edema during DKA treatment than adults.
Question 7: A patient presents with altered mental status, glucose of 38 mg/dL, and is conscious enough to swallow. What is the preferred initial treatment?
- 15–20 g of fast-acting carbohydrates orally (Correct answer)
- IV dextrose 50% (D50W) 25 g bolus
- Glucagon 1 mg subcutaneously
- A full meal with protein and fat
Correct answer: 15–20 g of fast-acting carbohydrates orally
If the patient can safely swallow, 15–20 g of fast-acting oral carbohydrates is the first-line treatment per the '15-15 rule' for conscious hypoglycemic patients.
Diabetes Education Certification Acute Complications Management 3
A 17-year-old with new-onset type 1 diabetes presents with Kussmaul breathing, fruity breath odor, and glucose of 480 mg/dL.
Which finding best confirms DKA over hyperglycemia alone?