You really don’t like to hang around. Live fast, die young is your philosophy, which is great for your maritally unsatisfied partner if you were a racing driver who has taken out life insurance. It is less good for a doctor. You give a rapid acting insulin analogue stat, mindful this is an emergency and therefore needs rapid treatment. However, this rapidly created hypoglycemia of 0.5 mmo/L, especially at that dose. This was treated with an intravenous glucose infusion.  However, everyone was now confused as to whether or not to continue insulin in a recently hypoglycemic patient in DKA. You call the medical SpR, who gives you a lollipop and asks you to sit in the doctors mess for a few minutes.

Score: 5/10 – The initial management was fine, but the choice of insulin wasn’t right. You need soluble insulin on a VRIII. That was a pretty intense dose of rapid acting Novorapid stat, which caused a severe hypoglycemia. The ABG was also unnecessary pain for no gain.