امرأة عمرها ٢٨ سنة عندها سكري النوع الأول، تستخدم مضخة إنسولين. استيقظت بغثيان وسكرها ٣٤٠، والكيتونات في الدم ٢٫٤، ولاحظت أن أنبوب المضخة منفصل من الليل. الحرارة طبيعية. ما الإجراء الأول؟

A 28-year-old with type 1 diabetes on an insulin pump wakes with nausea, glucose 340 and blood ketones 2.4, and finds the tubing disconnected overnight. Temperature is normal. What is the first action?

1. Rapid insulin by pen, change the set and monitor ketones
2. Stop insulin until the nausea has completely settled
3. Rely on the pump as usual and wait for glucose to fall alone
4. Take a large dose of basal insulin only

Answer: A) Rapid insulin by pen, change the set and monitor ketones. Pumps deliver only rapid insulin, so interruption for hours causes rapid ketosis. Give a correction dose by pen, change the site and tubing, drink fluids, check ketones and seek emergency care if persistent or vomiting.