Sugar, sugar

She's lying on the trolley as I walk past. A huge big mound of flesh, snoring. That doesn't sound right. What's this ladies story I ask. Brought in by ambulance with back pain. She's sweating profusely, pale and unresponsive and not really maintaining her airway. Since my CABG I do not try to lift people - especially someone as large as this lady - it hurts. So I can't turn her on her side. I try a jaw thrust with only a slight improvement in breathing - she has big fleshy jowls which are making it difficult to get good position. Airway, where will I get an airway? I've only worked in A&E for 15 years and this department has been opened for 10 years so where the h*ll are the airways? In the arrest trolley which is right next to me - idiot! I grab a nasopharyngeal airway, gel it and start to work it in - success, those ALS, ATLS and TNCC courses were good for something after all, not just an excuse to have a p*ss up. Her breathing immediately improves and this gives me time to get a blood sugar, 1.1mmols and considering "4's the floor" that's pretty damn low. She's cannulated and given IV glucose and within seconds she pulls her airway out, wakens up and starts ordering us about as if nothing had happened. This lady is a known (but not to us) diabetic, had taken her medication but had not eaten anything. I have seen this reaction before with patients who have very low BM's and it never ceases to amaze me how quickly people become better.