A 42-year-old client with type 1 diabetes for 20 years reports nausea, vomiting, and abdominal pain for 2 days. Her regimen is insulin glargine nightly with lispro at meals, but she has taken no basal or bolus insulin for 36 hours because she has not been eating. Her last A1C of 7.4 percent 3 months ago was near her target. She had a sore throat last week that has resolved and drinks wine socially, none in 2 weeks. At an endocrine visit last month, BP was 122/78 and HR 76. Now: BP 100/64 and HR 112, RR 26 with deep, regular breathing, and T 37.2 C and SpO2 98 percent on room air. She is alert, oriented, and answering promptly. Oral mucosa is dry, and she has voided twice in the past 24 hours.
一位42歲個案，患有第1型糖尿病20年，主訴噁心、嘔吐和腹痛2天。她的治療方案是每晚使用甘精胰島素，餐前使用賴脯胰島素，但因為沒有進食，她已36小時未注射基礎或餐前胰島素。她3個月前的糖化血色素為7.4%，接近目標值。她上週喉嚨痛已緩解，且社交性飲酒，近2週未飲酒。上個月內分泌科就診時，血壓為122/78毫米汞柱，心率為76次/分。現在：血壓100/64毫米汞柱，心率112次/分，呼吸速率26次/分，深而規律的呼吸，以及體溫37.2°C，室內空氣下血氧飽和度98%。她意識清楚，定向感良好，反應迅速。口腔黏膜乾燥，且她在過去24小時內排尿兩次。