Case presentation A 28-year-old man presented to his GP with the chief complaints of abdominal pain and brown/green-colored vomiting for five days. Medical history Type 1 diabetes since the age of four years, which has been poorly controlled since his teens. His last HbA1c performed in the clinic a month ago was 9.9%. He is currently on human insulin /soluble insulin 30% + isophane insulin /NPH 70% BD. Physical examination He seems unwell, drowsy, and peripherally cool and mottled.
Pulse - 125 bpm Blood pressure - 85/50 mmHg Fingerprick glucose - 26.1 mmol/L Temperature - 7.2 ° C, RR - 32/min Oxygen saturation: 95% on air JVP not seen; heart sounds normal. Chest clear. Abdomen - Generalised tenderness, no rebound, no guarding. Laboratory investigations are as follows: Na+: 130 mmol/L K: 7.1 mmol/L Urea: 30.3 mmol/L Creatinine: 368μmol/L Cl: 102 mmol/L Hb: 16.8 g/dL, WBC: 24.7 × 10 9/L,…
