- Is she unwell? Obs, NEWS2, vomiting, abdominal pain?
- Type 1 or type 2? On insulin? Any doses missed?
- Can you check capillary ketones?
Do now
- Check ketones: ≥ 3 mmol/L (or bicarbonate < 15) → think DKA
- Very high glucose, dehydrated, no big ketones → think HHS
- Well, ketones low: review regular diabetes medication
- Look for the trigger: infection, steroids, missed insulin
Key doses
- DKA: fluids + fixed-rate IV insulin 0.1 units/kg/h — follow the DKA protocol
- Type 1 with ketones 1.5–3 and well: correction dose per local protocol / diabetes team
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- DKA or HHS
- Unwell, vomiting, or drowsy
- Pregnant
Think of
- DKA
- HHS
- Infection
- Steroids
- Missed / incorrect insulin
Go deeper
The full walkthroughs behind this call.