A 16-year-old with weight loss, polyuria, polydipsia, and positive pancreatic autoantibodies arrives with blood glucose 420 mg/dL and ketonuria. Which is the immediate appropriate management and rationale?

• A. Start an SGLT2 inhibitor immediately because they are the safest agents in patients with ketonuria and eliminate the need for insulin in type 1 diabetes.
• B. Urgent initiation of intravenous insulin and fluid resuscitation because this presentation indicates type 1 diabetes with ketoacidosis risk requiring insulin to suppress ketogenesis and correct hyperglycemia.
• C. Advise high-carbohydrate diet to combat weight loss and postpone pharmacotherapy as the condition will self-correct in weeks without intervention.
• D. Begin metformin and schedule outpatient follow-up because oral agents are first-line for all adolescents with hyperglycemia including those with ketosis.

Answer: (B)