Test Your Knowledge Issue 470

This Week’s Question #470 - Diabetes In Control.com Newsletter

A 30-year-old woman who has had Type 1 diabetes for 10 years calls the clinic because she has had profuse watery diarrhea and nausea for 8 hours but without emesis. Her 12-year-old daughter had similar symptoms when she had viral gastroenteritis 2 days earlier. The patient has followed her sick-day rules and is drinking diet ginger ale alternating with regular ginger ale for hydration, but she is only able to take sips, and this is becoming increasingly difficult. Her blood glucose level is 256 mg/dL (14.21 mmol/L) and urinary ketones are moderate. She reports a dry mouth and dizziness on standing. Her usual insulin regimen is a basal-bolus therapy with insulin detemir twice daily and insulin lispro at meals.
Which of the following is the most appropriate next step for this patient to take?

A. Go to the emergency department for intravenous hydration.

B. Continue to follow sick-day rules and call again if urinary ketones are large.

C. Increase rapid-acting insulin by 20% of the total daily dose.

D. Stop taking any insulin until the ability to eat returns.