How Would You Manage This Patient With Diabetes?

Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started.

---

A 23-year-old man with a history of insulin-dependent diabetes presents to the ED with vomiting and shortness of breath. He recently became homeless and has not been using his insulin. On physical exam, he has a fruity odor to his breath. After two hours of treatment in the ED, his serum labs include glucose 190 mg/dL, sodium 133 mEq/L, chloride 101 mEq/L, and bicarbonate 12 mmol/L. Which of the following is the most appropriate next step in management?

A) Allow the patient to eat a turkey sandwich

B) Change to dextrose-containing intravenous fluid

C) Discharge home with endocrinology follow-up

D) Transition to subcutaneous insulin therapy

Check out all of the episodes of “The Reveal” on the Rosh Review YouTube Channel.