A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
The parents of a 14-year-old patient are concerned and have questions about the use of insulin for their son’s recently diagnosed type 1 diabetes. The patient has developed an upper respiratory infection while at school. He is coughing and has a runny nose. His temperature is 37.8° C (100.2° F) and vital signs are within normal limits. Physical examination is unremarkable. Which of the following modifications to his insulin regimen would you recommend to this patient and his parents?
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A
Increase the frequency of blood glucose checks.Correct. Increasing glucose monitoring frequency is the cornerstone of sick-day management for T1DM, allowing insulin dose adjustments to prevent illness-induced hyperglycemia and DKA.
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B
Reduce the insulin dose.Incorrect. Reducing insulin during illness is dangerous — stress hormones increase insulin needs and lower doses precipitate ketoacidosis.
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C
Continue same regimen.Incorrect. Continuing the same regimen ignores the increased insulin requirements during illness and risks DKA.
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D
Hold insulin until the patient gets better.Incorrect. Holding insulin entirely is the single most common cause of pediatric DKA — basal insulin must continue even during illness.
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E
Switch from basal-bolus to sliding-scale insulin onlyIncorrect. Sliding-scale-only insulin lacks basal coverage and reactively chases hyperglycemia, increasing the risk of DKA during illness; basal insulin must be continued and doses adjusted based on more frequent glucose monitoring.
↑ Tap an answer to reveal the reasoning
Answer: A. A child with type 1 diabetes who develops an intercurrent illness (here a URI) experiences **stress-hormone–driven hyperglycemia**: counter-regulatory hormones (cortisol, catecholamines, glucagon, growth hormone) rise during infection and antagonize insulin, increasing insulin requirements and predisposing to diabetic ketoacidosis (DKA). "Sick-day rules" therefore emphasize **more frequent glucose monitoring — every 2–4 hours — along with checking urine or blood ketones**, maintaining hydration and carbohydrate intake, and adjusting (usually *increasing*, not reducing) insulin doses.
Core sick-day teaching points for type 1 diabetes:
1. **Never stop insulin**, even if the child is eating less — basal insulin is always required to suppress lipolysis and ketogenesis.
2. **Check glucose every 2–4 hours**.
3. **Check ketones** when glucose is > 240 mg/dL or with vomiting.
4. **Adjust insulin doses upward** based on glucose and ketones; consult the diabetes team for correction doses.
5. Maintain hydration with sugar-free fluids if glucose is high, sugar-containing fluids if hypoglycemic.
6. Seek care for persistent vomiting, ketones, or dehydration.
Reducing or holding insulin during illness is the single most common pitfall and the most common cause of DKA in pediatric T1DM.
**Why each option:**
**A.** Increasing glucose monitoring frequency is the cornerstone of sick-day management for T1DM, allowing insulin dose adjustments to prevent illness-induced hyperglycemia and DKA.
**B.** Reducing insulin during illness is dangerous — stress hormones increase insulin needs and lower doses precipitate ketoacidosis.
**C.** Continuing the same regimen ignores the increased insulin requirements during illness and risks DKA.
**D.** Holding insulin entirely is the single most common cause of pediatric DKA — basal insulin must continue even during illness.