Diabetes mellitus & glycemic management Practice Test

A 24-year-old man with a 10-year history of type 1 diabetes presents to the emergency department with nausea, vomiting, and abdominal pain for the past 24 hours. He reports having a flu-like illness and has been unable to eat. He decreased his insulin dose due to poor oral intake. His temperature is 37.5°C (99.5°F), blood pressure is 100/60 mm Hg, heart rate is 115/min, and respirations are 28/min and deep. Laboratory studies show:

Sodium: 132 mEq/L

Potassium: 3.1 mEq/L

Chloride: 95 mEq/L

Bicarbonate: 8 mEq/L

BUN: 30 mg/dL

Creatinine: 1.4 mg/dL

Glucose: 550 mg/dL

Anion gap: 29 mEq/L

Serum ketones: Positive

Arterial pH: 7.15

A 68-year-old woman with a history of type 2 diabetes, hypertension, and coronary artery disease is admitted to the hospital for community-acquired pneumonia. She is started on intravenous antibiotics and supplemental oxygen. Her home medications include metformin, lisinopril, and atorvastatin. Her oral intake is poor. Her blood glucose levels, checked before meals and at bedtime, have ranged from 220 to 280 mg/dL despite a sliding-scale insulin regimen.