A 37-year-old female with diabetes presents with excessive urination and weakness for 2 days. Her blood glucose is 320 mg/dL. If untreated, she will most likely develop:

• A. hypoxia and overhydration
• B. irreversible renal failure
• C. severe insulin shock
• D. acidosis and dehydration

Answer: (D)

When blood glucose rises in untreated diabetes, the kidneys try to remove the excess sugar, pulling water along with it. That osmotic diuresis causes significant fluid loss, or dehydration. At the same time, a lack of insulin prompts the body to break down fats, producing ketone bodies that accumulate and lower the blood pH, leading to metabolic acidosis. Together, dehydration and acidosis are the hallmark progression you’d expect in this scenario, especially with symptoms of polyuria and weakness and a glucose level around 320 mg/dL. The other options don’t fit as well: severe insulin shock would come from low glucose, not high; hypoxia with overhydration and irreversible renal failure aren’t the immediate, typical complications of untreated hyperglycemia in this context.