An 18-year-old with diabetic ketoacidosis presents with altered consciousness and fruity breath. Which medication is indicated for rapid glucose control?

• A. NPH insulin
• B. Glyburide (Diabeta)
• C. Regular insulin
• D. Metformin (Glucophage)

Answer: (C)

In diabetic ketoacidosis, rapid glucose control is best achieved with intravenous regular insulin. This short-acting insulin, given IV, acts quickly to lower blood glucose and suppress ketone production, helping to reverse the metabolic derangements of DKA. Its effects can be titrated promptly to the patient’s needs, which is essential in a serious, acutely ill state with altered consciousness.

Other options don’t fit for rapid IV correction: an intermediate-acting insulin is not suitable for emergent IV use and won’t provide the needed fast control; a sulfonylurea would stimulate insulin release but isn’t appropriate when there’s profound insulin deficiency and altered consciousness; metformin isn’t used in acute DKA due to contraindications in acidosis and does not provide the rapid IV action required.