Our December 8th Question of the week was a question of interventions. Over 71% of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: A 12-year-old with new-onset hyperglycemia presents to the Emergency Room with positive urine ketones and blood sugar of 283. What action is required most immediately?

Answer Choices:

• Contact dietitian to provide macronutrient review.
• Start a person with diabetes on Metformin (Glucophage).
• Draw ABGs and antibodies.
• Provide insulin therapy.

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As shown above, the most common choice was option 4, the second most common answer was option 3, then option 2, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam questions won’t have 2 right answers, but alcohol and diabetes is expected content on the exam.

Answer 1 is incorrect. 1.98% chose this answer. “Contact dietitian to provide macronutrient review.” All people with diabetes benefit from a consultation with a dietitian. However, in this crisis situation, the first priority is not a macronutrient review. The first priority is to stop ketosis.

Answer 2 is incorrect. 2.31% of you chose this answer. “Start a person with diabetes on Metformin (Glucophage).” Given that this is a teenager with positive ketones, we are suspecting type 1 diabetes. With that information, starting metformin would not be a recommended intervention.

Answer 3 is incorrect, 23.8% of you chose this answer “Draw ABGs and antibodies.” The question asks what action to take immediately. If you chose this answer, you are on the right track. You want to verify a diagnosis of type 1 diabetes by evaluating if they are acidotic and have positive autoantibodies. An immediate action would include checking ABG’s but not antibodies. Antibodies would most likely be drawn after the patient is stabilized.

Answer 4 is correct, 71.9% of you chose this answer. “Provide insulin therapy. ” Elevated blood glucose and positive ketones always indicate that the person is insulin deficient. When there is not enough circulating insulin, the body can’t use glucose for fuel, so it uses fat for fuel which leads to ketone bodies. To stop fat breakdown, immediate insulin infusion is required along with fluids to treat dehydration.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want to learn more? Register for our
Level 2 – Hyperglycemic Crisis. DKA and HHS 2021 course, which is ready for viewing.

Join Coach Beverly to learn about unexpected causes of hyperglycemia and strategies to get blood glucose levels to goal. Topics include hyperglycemia secondary to medications and insulin deprivation. She also reviews Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome, with new information on treating DKA with subq insulin therapy. Treatment strategies for all situations are included.

Topics include:

• Common causes of hyperglycemic crises.
• The difference and similarities between DKA and HHS and treatment strategies
• Causes and treatment of hyperglycemic crises.

Can’t join us live?
Don’t worry, we will send you a link to the recorded version.

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