You recall that soluble insulin is used…but your recent placement on surgical wards with variable rate intravenous insulin infusions (VRIII) being used perioperatively for fasting diabetic patients has muddled your mind slightly. Variable rate infusions risk the insulin supply going right down…whereas in this case we need a constant amount of insulin at all times to completely suppress switch off ketogenesis. Luckily, the initial rate for the VRIII and the fixed rate infusion is pretty similar, so by the time the Med Spr came to review the patient, he was still alive.
Score: 8/10
The patient is alive, but it was lucky the Med Spr came to review the patient before the sliding scale/VRIII potentially undid some of your excellent work at stopping ketogenesis. The ABG was pain and no gain.