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Always Ask What Type

Aug 16, 2016

Female, 32 years of age, well aware of the fact she had type 1 diabetes, was suicidal, who reported she chose to stop taking her insulin a few days earlier. Was taken to the police station on a warrant (unknown reason), who took her to the ED due to her report of suicidal ideation. She was found to be hyperglycemic at that time, but did not say she had type 1. Acetone was negative. Given 5 units regular insulin and sent back with police. She then started complaining of not feeling well, taken back to ED, no treatment and sent back with police. The next morning, complained of nausea, vomiting, and abdominal pain. She was in full blown DKA. Admitted to ICU, insulin drip. Treatment plan included diabetes education and a psych consult.

Lessons Learned:
• When seeing someone who says they have diabetes, always ask what type of diabetes.
• If patient doesn’t know if type 1 or type 2, assess further and treat appropriately, even if this includes referring to endocrinologist.
• People who have type 1 diabetes can quickly go into DKA without appropriate treatment with insulin.
• All people who have diabetes should be referred for diabetes education to understand their condition, especially those admitted with type 1 diabetes either newly diagnosed and/or admitted in DKA.
• Patients who are frequently admitted with DKA or unusual reason for DKA should receive psych consult.
• Patients who have type 1 diabetes need to be taught the importance of taking their insulin, their life line.


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