Question 1 of 12
A 13-year-old boy with type 1 diabetes is brought to the hospital complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15.
Which of the following agents should be administered to achieve rapid control of the severe ketoacidosis in this diabetic boy?
Crystalline zinc insulin
Insulin glargine
NPH insulin
Oral antidiabetic agents (listed in Table 41–1) are inappropriate in this patient because he has insulin-dependent diabetes. He needs a rapid-acting insulin preparation that can be given intravenously (see Figure 41–1). The answer is A.
FIGURE 41–1 Extent and duration of action of various types of insulin as indicated by the glucose infusion rates (mg/kg/min) required to maintain a constant glucose concentration. The durations of action shown are typical of an average dose of 0.2–0.3 U/kg; the duration of regular and NPH insulin increases considerably when dosage is increased. (Reproduced, with permission, from Katzung BG, editor: Basic & Clinical Pharmacology, 12th ed. McGraw-Hill, 2012: Fig. 41–5.)
| Drug | Duration of Action (hours) |
|---|---|
| Secretagogues | |
| Chlorpropamide | Up to 60 |
| Tolbutamide | 6–12 |
| Glimepiride | 12–24 |
| Glipizide | 10–24 |
| Glyburide | 10–24 |
| Repaglinide | 4–5 |
| Nateglinide | 4 |
| Biguanides | |
| Metformin | 10–12 |
| Thiazolidinediones | |
| Pioglitazone | 15–24 |
| Rosiglitazone | >24 |
| Alpha-glucosidase inhibitors | |
| Acarbose | 3–4 |
| Miglitol | 3–4 |
| Incretin modifiers | |
| Sitagliptin | 8–14 |
| SGLT2 inhibitors | |
| Canagliflozin | 10–14 |