Título Em Endocrinologia E Metabologia Practice Questions - TEEM - Título De Especialista Em Endocrinologia E Metabologia (SBEM AMB) Exam

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A 22-year-old female with type 1 diabetes mellitus (T1DM) is admitted to the emergency department with severe diabetic ketoacidosis (cetoacidose diabética - CAD). Initial labs revealed blood glucose 480 mg/dL, arterial pH 7.12, serum bicarbonate 10 mEq/L, and anion gap 24 mEq/L. She is treated with intravenous normal saline, potassium replacement, and continuous regular insulin infusion. After 14 hours of infusion, her capillary glucose is 180 mg/dL, venous pH is 7.34, serum bicarbonate is 19 mEq/L, and calculated anion gap is 10 mEq/L. She is alert, nausea has resolved, and she requests lunch. According to SBEM and SBD protocols, what is the most appropriate management at this stage?

Administer subcutaneous basal insulin along with prandial rapid-acting insulin 1 to 2 hours before stopping the intravenous insulin infusion. Immediately turn off the intravenous insulin infusion and start oral metformin plus NPH insulin. Discontinue intravenous fluids and insulin immediately, allowing the patient to eat regular meals while monitoring blood glucose every 6 hours. Continue intravenous insulin infusion at the same rate and withhold all oral intake until the serum bicarbonate exceeds 24 mEq/L.

Correct Answer:

Administer subcutaneous basal insulin along with prandial rapid-acting insulin 1 to 2 hours before stopping the intravenous insulin infusion.

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