Hypoglycaemia in diabetes — branching viva

Emergency department: a six-year-old boy with an 18-month history of type 1 diabetes on an insulin pump is brought in after a generalised seizure at 7 am, now post-ictal and drowsy, with a sensor glucose of 1.5 mmol/L. His mother gave intranasal glucagon before calling the ambulance. The examiner asks: what is your immediate management and how do you classify the event, why did his counter-regulation fail and why was the nocturnal event silent, what is the rule of 15 and when is glucagon or intravenous dextrose indicated, and what is the structured prevention plan — then branches to an eight-year-old with impaired awareness and three severe events in six months, and asks you to discuss HAAF, two-to-three-week hypoglycaemia avoidance, and hybrid closed-loop technology, and finally to the dead-in-bed syndrome and the equity of technology funding.