Jessica's GP's keen sense of smell pays off as a urine dipstick shows Glucose and Ketones.
NOTE: only about 50% of the population can smell ketones on the breath
Point-of-care blood sugar testing reveals a blood glucose of 42 mmol/L.
Jessica is a 13-year-old girl who attends her GP with a one day history of chest pain.
The pain is right sided and sharp with inspiration and has been coming and going throughout the day.
At its worst the pain scores 5-6/10 but it hasn't stopped Jessica attending school today.
Whilst examining Jessica her doctor notices that her breath smells Ketotic (a sweet Acetone smell) and decides to ask a little more history.
Jessica says that she went to the shops 3 days earlier and suffered from an unquenchable thirst. She has drunk large amounts of fluid over the weekend and her mother has noticed her getting up in the night to pass urine.
She reports dizziness and lethargy over last weekend that meant she didn't go out.
She has vomited twice in the doctor's waiting room.