Acute Complications Management Flashcards

A patient with type 1 diabetes has been vomiting for 6 hours and cannot keep food down. Blood glucose is 260 mg/dL with moderate urine ketones. What is the most appropriate advice under sick-day rules?

Answer: Continue basal insulin, check glucose and ketones every 2–4 hours, and seek emergency care if ketones worsen

During illness, basal insulin must be continued to prevent DKA; frequent monitoring and emergency care for worsening ketones are essential components of sick-day management.

A patient's blood glucose is 42 mg/dL 90 minutes after eating dinner. Which medication taken before dinner is most likely responsible?

Answer: Rapid-acting insulin lispro

Rapid-acting insulin analogs like lispro peak within 1–2 hours after injection, making postprandial hypoglycemia a direct risk if the dose was excessive.

In treating HHS, why must blood glucose be lowered gradually rather than rapidly?

Answer: Rapid glucose lowering can cause osmotic cerebral edema from rapid fluid shift into brain cells

Rapid lowering of serum osmolality in HHS can cause fluid to shift into osmotically adapted brain cells, resulting in cerebral edema.

A patient reports that their continuous glucose monitor (CGM) showed a rapid glucose drop from 180 to 75 mg/dL over 30 minutes during exercise. What is the most appropriate management step?

Answer: Stop exercise and consume 15 g of fast-acting carbohydrates prophylactically

A rapid downward CGM trend during exercise warrants prophylactic carbohydrate intake to prevent hypoglycemia before the level becomes dangerously low.

Which of the following is the most sensitive laboratory test to detect early DKA before significant acidosis develops?

Answer: Serum beta-hydroxybutyrate level

Serum beta-hydroxybutyrate is more sensitive and specific than urine ketone dipsticks (which primarily detect acetoacetate) for early DKA detection.

A patient on SGLT2 inhibitor therapy presents with glucose of 210 mg/dL, nausea, and elevated ketones. What rare but serious condition should be suspected?

Answer: Euglycemic diabetic ketoacidosis

SGLT2 inhibitors can cause euglycemic DKA, where ketoacidosis occurs with near-normal or only mildly elevated blood glucose, making it easy to miss.

A patient with type 1 diabetes wakes at 3 AM with diaphoresis, tremor, and glucose of 52 mg/dL. What phenomenon should be evaluated if this pattern recurs frequently?

Answer: Somogyi effect (rebound hyperglycemia)

The Somogyi effect involves nocturnal hypoglycemia triggering counter-regulatory hormone release, causing rebound hyperglycemia in the early morning hours.