Answer 1 is correct. 43.04% chose this answer. “Administer low dose basal insulin analog in addition to intravenous insulin infusion to improve glucose management.”  YES, great job, this is the best answer. According to ADA Standard 16 on Hospital Care, “Studies have reported that the administration of a low dose of basal insulin analog in addition to intravenous insulin infusion may prevent rebound hyperglycemia without increased risk of hypoglycemia.”  

Answer 2 is incorrect. 19.59% of you chose this answer. “If serum pH is below 7.4, administer IV bicarb, along with a glucose infusion to resolve severe acidosis.” Since this pH is in the normal range, this person is not in ketoacidosis.  According to ADA Standard 16 on Hospital Care, “Several studies have shown that the use of bicarbonate in people with DKA made no difference in the resolution of acidosis or time to discharge, and its use is generally not recommended.”

Answer 3 is incorrect. About 20.10% of respondents chose this. “To differentiate between DKA and HHS, the most important lab indicators are the anion gap and glucose levels.”  According to the 2024 Consensus Statement, to differentiate between the two conditions, the most decisive lab indicators are beta hydroxybutyrate or urine ketones to verify insulin deficiency along with pH levels to verify acidosis and osmolality to determine hydration status in HHS.  

Finally, Answer 4 is incorrect. 17.27% chose this answer. “Lactated Ringers is now the preferred intravenous solution for fluid resuscitation.”  According to the 2024 Consensus Statement, Normal saline or Ringer’s lactate are both accepted IV rehydration solutions.

You are invited to register for our Hyperglycemic Crises – New criteria and treatment guidelines for DKA, Euglycemic DKA and HHS | 1.25 CE – Recorded and Ready for Viewing.

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!