13 Clinical Scenarios

Adam missed his basal insulin. Glucose is climbing toward the DKA danger zone with no coverage. Stress hormones are compounding the rise.

Teaching objective: Recognize the DKA pathway, understand why insulin is never optional, and practice aggressive correction with dual insulin strategy.

Khalid is in the honeymoon phase. His residual beta-cell function makes dosing unpredictable. Every 0.1U matters. Use the precision dose dial to hit the exact correction.

Teaching objective: Practice the correction dose formula: (BG − 120) ÷ ISF − IOB. Master the insulin pen dial and understand honeymoon-phase variability.

Sofia eats a high-fat meal. The first glucose spike comes, then falls — but 90 minutes later, a second wave hits as dietary fat slows gastric emptying. One bolus isn't enough.

Teaching objective: Understand biphasic glucose response to high-fat meals and master the split bolus (or extended bolus) technique.

Yuki has a fever and is vomiting. Illness causes significant insulin resistance through stress hormones. Glucose is rising fast despite not eating.

Teaching objective: Learn the sick day rules — never skip insulin even when not eating, increase monitoring frequency, watch for ketones every 2 hours.

It's 2am. Rayan is asleep with 0.8U of active bolus insulin still working. This is the most dangerous type of hypoglycemia — he cannot self-treat. CGM alarms are his only safety net.

Teaching objective: Understand nocturnal hypo risk, the importance of pre-bed glucose checks, CGM alarm thresholds, and Somogyi rebound hyperglycemia.

Amara is sitting an exam. The adrenaline surge raises her glucose without any food. This is psychological stress hyperglycemia — and then post-stress sensitivity makes overcorrection dangerous.

Teaching objective: Recognize cortisol-driven hyperglycemia, apply conservative correction, and predict post-stress insulin sensitivity rebound.

Jae's closed-loop insulin pump has failed due to sensor occlusion. The algorithm is blind. You must take over manual insulin delivery while 0.6U of IOB is still active.

Teaching objective: Practice technology-independent T1D management. Every person with T1D must know how to manage without their device.

Nadia is 28 weeks pregnant — the point of peak insulin resistance. Glucose targets are dramatically tighter: 63–140 mg/dL instead of the standard 70–180. Insulin needs have risen 60%.

Teaching objective: Apply pregnancy-specific glucose targets, master aggressive pre-bolusing, and understand the fetal risks of hyperglycemia above 140 mg/dL.

Marco has T2D managed with metformin only — no insulin. Exercise is his primary glucose management tool. A well-timed workout drops glucose 30–50 mg/dL and boosts sensitivity for 24–48 hours.

Teaching objective: Understand non-insulin glucose management, exercise timing strategy, and residual beta-cell function in early T2D.

Zara has been drinking. Alcohol blocks the liver's ability to release glucose (hepatic gluconeogenesis). A severe hypoglycemia hits 4–8 hours later — and glucagon will not work.

Teaching objective: Understand alcohol-induced hypoglycemia, why glucagon is ineffective, and the critical importance of overnight monitoring and carb snacks before sleep.