Ms Nancy Huang is a 29 year old university student undertaking her honour’s year in physics.  Nancy was diagnosed as a type 1 diabetic three years ago.  She normally manages her diabetes reasonably well. She made a number of lifestyle changes and uses regular insulin therapy.   Nancy has been very stressed, as she has not been able to finish her thesis on time due to having to recently return to China unexpectedly to attend a family funeral.  Since returning to Australia a few days ago, she has seen her GP, as she was unwell. She was diagnosed with a viral chest infection that was managed conservatively. She subsequently fell further behind in her studies.  Nancy decided to pull a few ‘all-nighters’ to get her thesis finished and consumed excessive amounts of coffee and soft drinks in order to stay awake to get finished.  The next day her husband noticed Nancy was particularly irritable and becoming emotional. She explained that she could not concentrate enough to finish her thesis.  Nancy was insisting on being driven to the university to speak to her lecturer.  On the drive in, they had to stop 4 times for Nancy to use the bathroom.  She became even more irritable and her husband decided to call an ambulance once they arrived at the university. After assessment by the paramedics, Nancy was transported to hospital.

You undertake additional assessments to gather new information, recording the following new data:  Vital signs:  BP: 90/50 Pulse: 120 bpm RR: 20, coarse air entry, moist productive cough Sp02: 94% Temp: 37.9 ° C Other data: BGL: 24 mmol/L GCS: 13 (confused) Poor skin turgor Frequent urination Urinalysis: glycosuria, specific gravity 1.000, no ketones present Abdomen soft, no rebound tenderness. Bowel sounds present. Patient irritable and agitated. Speaking in a confused mixture of English and Mandarin. Husband in attendance

Log book: Ms Huang’s husband gives you a logbook that Nancy has been provided with by her endocrinologist. It shows that Nancy has been diligently recording her blood glucose levels and insulin regime for several months. You note there are no entries for the last few days.