Diabetic emergencies are serious medical conditions where blood sugar levels become dangerously unbalanced, either too low or too high. These situations can overwhelm the body’s systems, leading to severe complications or even be life-threatening if not promptly addressed. Recognizing the signs of these emergencies and knowing how to respond can make a significant difference in outcomes for individuals with diabetes and those around them.
Recognizing Low Blood Sugar
Low blood sugar, known as hypoglycemia, occurs when blood glucose levels drop below 70 milligrams per deciliter (mg/dL). It is common in type 1 diabetes. Hypoglycemia can arise from various factors, including too much insulin or medication, skipped meals, increased physical activity without adjusting intake, or consuming too much alcohol.
Symptoms of hypoglycemia can develop quickly and vary among individuals. Early signs often include feeling pale, shakiness, sweating, and experiencing a fast or irregular heartbeat. Other early signs include headaches, hunger, nausea, fatigue, irritability, anxiety, or tingling/numbness in the lips, tongue, or cheek.
As blood sugar levels continue to drop, symptoms can worsen, affecting cognitive function and coordination. Symptoms include confusion, unusual behavior, or difficulty completing routine tasks. Slurred speech, blurred vision, or tunnel vision are also possible. In severe cases, hypoglycemia can lead to loss of coordination, muscle weakness, drowsiness, seizures, or even loss of consciousness. Some individuals may experience “hypoglycemia unawareness,” where their body no longer produces the usual warning signs, increasing the risk of severe episodes.
Recognizing High Blood Sugar
High blood sugar emergencies, or hyperglycemic crises, include Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). DKA is more common in people with type 1 diabetes and results from insufficient insulin, leading the body to break down fat for energy, which produces acidic byproducts called ketones. HHS is primarily seen in individuals with type 2 diabetes, where the body produces some insulin, but it doesn’t work effectively, leading to extremely high blood glucose levels and severe dehydration without significant ketone buildup.
Common triggers for DKA include infections like pneumonia or urinary tract infections, missed insulin doses, or problems with insulin pump function. Other causes can involve heart attack, stroke, physical injury, or certain medications such as corticosteroids. Symptoms of DKA often appear within 24 hours and can include excessive thirst, frequent urination, nausea, vomiting, and abdominal pain. Individuals may also experience weakness, fatigue, shortness of breath, and a distinctive fruity odor on their breath due to ketones. Confusion or decreased alertness can also occur.
HHS is triggered by similar factors, such as infections, other illnesses like heart attack or stroke, or certain medications that increase fluid loss or decrease insulin effectiveness. The onset of HHS symptoms is slower, developing over days to weeks. Key indicators of HHS include extreme thirst, frequent urination, and signs of severe dehydration, such as dry mouth and sunken eyes. Neurological symptoms are prominent in HHS, ranging from mild confusion and disorientation to drowsiness, seizures, and even coma. Unlike DKA, HHS does not involve a significant presence of ketones.
Immediate Steps During an Emergency
For low blood sugar, if the individual is conscious and able to swallow, the “rule of 15” should be applied. This involves consuming 15 grams of a fast-acting carbohydrate, such as 4 ounces of fruit juice, regular soda, or 3-4 glucose tablets. After 15 minutes, blood sugar should be rechecked; if it remains below 70 mg/dL, another 15 grams of fast-acting carbohydrates should be consumed, repeating the process until blood sugar is at least 70 mg/dL. Once blood sugar is in range, a snack or meal should be eaten to prevent another drop.
If an individual with low blood sugar becomes unconscious or is unable to swallow, emergency glucagon should be administered. Glucagon is a hormone that prompts the liver to release stored glucose. After administering glucagon, the person should be rolled onto their side, as nausea and vomiting can be a side effect. Emergency services should be called immediately if the person is unconscious or if symptoms worsen.
For high blood sugar emergencies, such as DKA or HHS, checking for ketones is a primary step, especially if blood sugar is 240 mg/dL or above. Over-the-counter urine ketone test kits or blood ketone meters can be used. Increasing fluid intake with water or sugar-free beverages is also important to combat dehydration. If ketone levels are moderate to high, or if symptoms like persistent vomiting, severe abdominal pain, rapid breathing, or confusion are present, urgent medical attention is necessary. Treatment usually includes intravenous fluids, electrolyte replacement, and insulin therapy to lower blood sugar and correct imbalances.
Reducing Risk
Preventing diabetic emergencies involves self-management strategies. Regular blood sugar monitoring is a primary defense, allowing individuals to identify and address fluctuations before they become severe. Adhering to prescribed medication schedules, whether insulin or oral medications, is equally important. Maintaining a balanced diet and engaging in regular physical activity also contribute to stable blood glucose levels.
Stress management techniques can help, as stress can influence blood sugar. Carrying emergency supplies, such as fast-acting glucose for hypoglycemia or a glucagon kit, ensures readiness for unexpected drops. Individuals should also maintain regular communication with their healthcare providers to adjust treatment plans as needed and to receive guidance on managing “sick-day rules.” These rules outline how to adjust medication and monitor blood sugar and ketones during illness, when blood glucose levels can become unpredictable.