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According to the case study, what initial management steps are recommended for a young adult presenting with diabetic ketoacidosis (DKA) and suspected type 1 diabetes?

The initial recommended steps are to manage the DKA with a fixed-rate intravenous insulin infusion and IV fluids, while also commencing long-acting insulin and continuing it alongside the IV infusion; urgently refer to the inpatient diabetes team; take blood for C-peptide, paired glucose, and autoimmune antibody tests; and convert to a regular subcutaneous insulin regimen once the DKA has resolved.

Key points

  • Commence DKA management with a fixed-rate IV insulin infusion and IV fluids.
  • Start long-acting insulin at the same time and continue it while the IV insulin infusion is running.
  • Make an urgent referral to the inpatient diabetes team for education and support.
  • Send blood samples for C-peptide, paired glucose, and autoimmune antibody testing to confirm type 1 diabetes.
  • Once DKA has resolved, switch the IV insulin to a regular subcutaneous insulin regimen.
  • Provide basic diabetes education, including injection technique, glucose and ketone monitoring, hypoglycaemia management, and diet advice.
Source:Oxford Handbook of Diabetes Nursing· Insulin use in diabetes· p. 73–81

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