A 12-year-old boy is newly diagnosed with type 1 diabetes (HbA1c 11.2%, random glucose 380 mg/dL, ketones trace). He is alert and not in DKA. What is the MOST appropriate initial management?
- A Basal-bolus insulin regimen with education on carbohydrate counting and self-monitoring ✓
- B Oral metformin plus dietary modifications
- C Hospital admission for mandatory IV insulin infusion protocol for 72 hours
- D Once-daily long-acting insulin only until HbA1c normalizes
Correct answer: A. Basal-bolus insulin regimen with education on carbohydrate counting and self-monitoring
Explanation
Newly diagnosed, metabolically stable type 1 DM without DKA can be managed in an outpatient setting with a basal-bolus insulin regimen (long-acting insulin + rapid-acting prandial insulin), along with structured diabetes education including carbohydrate counting and self-monitoring of blood glucose. Metformin is not indicated in type 1 DM. Once-daily insulin alone is insufficient for physiological insulin replacement. Hospitalization is reserved for DKA or when outpatient management is not feasible.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.