A 22 year old newly qualified nurse was brought into the accident and emergency department in a comatosed state. In the past she had complained of feeling extremely unwell and nauseous in the mornings which had resulted in her being sent home from duty on several occasions.
On examination she smelt of alcohol and had dilated pupils which reacted very sluggishly to light. All other physical examination was normal.
blood glucose 0.3 mmol/L
simultaneous serum insulin level 130 U/L