You are treating a 40-year-old male with a documented blood sugar reading of 480 mg/dL. The patient is semiconscious and breathing shallowly, and is receiving assisted ventilation from your partner. Definitive treatment for this patient includes:

• A. dextrose
• B. insulin
• C. oxygen
• D. glucagon

Answer: (B)

In a severe hyperglycemic crisis like diabetic ketoacidosis, the key treatment is insulin. The lack of insulin and excess stress hormones push glucose up and drive ketone production, causing dehydration, acidosis, and altered mental status. Insulin therapy directly addresses the root problem by promoting glucose uptake into cells and stopping ketogenesis, which helps lower blood glucose and reverses the metabolic acidosis. It also shifts potassium from the bloodstream into cells, so electrolyte monitoring and management are essential alongside fluids. Dextrose would be used later to prevent hypoglycemia once insulin has begun and glucose starts to fall, not as the initial definitive therapy. Oxygen and glucagon don’t treat the underlying metabolic derangements of a hyperglycemic crisis, though oxygen may be supportive if hypoxia is present. Therefore, insulin therapy is the best answer.