29th May 2025

A 64-year-old patient with a known history of type 2 diabetes controlled with a basal-bolus insulin regime presents to the emergency department with complaints of nausea, vomiting, and abdominal pain.

A 64-year-old patient with a known history of type 2 diabetes controlled with a basal-bolus insulin regime presents to the emergency department with complaints of nausea, vomiting, and abdominal pain. On examination, the patient appears anxious and is breathing deeply. Laboratory tests reveal a plasma glucose level of 620mg/dL, osmolarity of 310 mOsm/L a pH of 7.2, a serum bicarbonate level of 12mEq/L, pH of 7.24 and a positive urine dipstick for ketones. The patient is hemodynamically stable. Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.