A patient with diabetic ketoacidosis is treated immediately. Which regimen is most appropriate to initiate?

• A. Regular insulin subcutaneously
• B. Metformin
• C. Hypoglycemic infusion
• D. Insulin Actrapid intravenously in sodium chloride 0.9%

Answer: (D)

In diabetic ketoacidosis, the fastest, most controllable way to reverse the metabolic crisis is to give insulin intravenously. Using a rapid-acting, regular insulin through an IV infusion allows immediate and titratable correction of high blood glucose and the acidosis, while the IV fluid provides the necessary volume to restore perfusion and renal function. Actrapid is a regular insulin suitable for IV use, and pairing it with normal saline ensures both insulin delivery and ongoing fluid resuscitation.

Subcutaneous insulin would not act quickly or predictably enough in this dehydrated, acutely ill state. Metformin is not appropriate in acute DKA and is contraindicated due to lactic acidosis risk and the need for rapid, comprehensive metabolic correction. A hypoglycemic infusion isn’t a valid regimen for this crisis.