Nikki, a slightly built 30-year-old woman with a 10-year history of type 1 diabetes, is brought to ED by ambulance with an altered level of consciousness and tachypnoea.

She was discharged from hospital the day before after recovering from an episode of diabetic ketoacidosis (DKA).

Nikki’s mother called in to check on her when Nikki did not answer the phone and found her slumped on the floor at home, slurring her speech and not able to mobilise. Nikki’s mother calls an ambulance.

By the time the paramedics bring her to ED, she has a Glasgow Coma Scale of 11 (E3M3V5) and is unable to provide any history, only producing garbled words when responding to verbal cues.