A diabetic emergency refers to severe hypoglycemia, a dangerously low blood sugar level. Glucose is the primary fuel source for the brain. When blood sugar drops below the healthy range, typically under 70 milligrams per deciliter (mg/dL) for people with diabetes, the body cannot function properly. Quick intervention is necessary because untreated severe hypoglycemia can rapidly lead to confusion, seizures, loss of consciousness, and is potentially life-threatening.
Recognizing the Signs of Severe Hypoglycemia
Hypoglycemia symptoms range from mild to severe. Mild symptoms, which a person can often treat themselves, include shakiness, sweating, and extreme hunger. These initial signs warn that the blood sugar level is dropping and requires attention.
Severe symptoms indicate the person requires immediate assistance because the brain is starved of glucose. These symptoms include profound confusion, disorientation, slurred speech, and an inability to safely swallow. At this stage, the person may also experience a seizure or lose consciousness.
Severe hypoglycemia is often considered a blood sugar level below 54 mg/dL. At this point, the individual is no longer able to self-treat. The urgent need for glucose results in symptoms caused by impaired brain function. Prompt identification of these severe signs requires a caregiver to intervene immediately.
The Immediate 15-15 Rule for Treatment
For a conscious person experiencing mild to moderate hypoglycemia, the standard protocol is the “15-15 Rule.” This rule begins with consuming 15 grams of a fast-acting carbohydrate source. This amount is specifically chosen because it is sufficient to raise blood glucose levels quickly without causing an overshoot into hyperglycemia.
After the initial 15-gram dose, the individual should wait 15 minutes before checking their blood sugar again. This waiting period allows time for the simple sugars to be absorbed into the bloodstream. If the blood sugar reading remains below the target level (typically 70 mg/dL), the 15-gram dose and 15-minute waiting period should be repeated.
This approach can be repeated up to three times if the blood sugar remains low and the person is able to swallow. Repeating the 15-gram dose provides a controlled, incremental rise in blood sugar. Once the glucose level is back in the safe range, a small snack containing protein and complex carbohydrates should be eaten. This stabilizes the sugar and prevents a recurrence of the low blood sugar episode.
Recommended Sources of Fast-Acting Glucose
The effectiveness of the 15-15 rule depends on using a source of pure, fast-acting sugar that is quickly absorbed. The most reliable options are designed glucose products, such as tablets or gel. Three to four tablets or one tube of gel typically delivers the required 15 grams of carbohydrate. These products are preferred because they contain nearly pure dextrose, which the body processes instantly.
Common household items also provide an approximate 15-gram dose. The source must be a simple carbohydrate without significant fat or protein content.
15-Gram Glucose Sources
- Four ounces of fruit juice (such as orange or apple juice).
- Four ounces of regular, non-diet soda.
- One tablespoon of table sugar, honey, or corn syrup.
Sources high in fat, such as chocolate, cookies, or whole milk, should be avoided in an emergency, even if they contain sugar. The fat content in these items significantly slows down the rate at which the body can absorb the glucose, delaying the necessary rise in blood sugar. The goal is the fastest possible absorption to correct the dangerous glucose deficit.
When Emergency Services Are Required
There are circumstances where the 15-15 rule must be bypassed in favor of immediate medical attention. If the person is unconscious, having a seizure, or is too confused or uncooperative to safely swallow, calling the local emergency number is the first and most important step. Attempting to give food or liquid to someone who cannot swallow poses a serious risk of choking or aspiration.
In these severe situations, an emergency glucagon injection or nasal spray is the medical intervention of choice if available and if a caregiver is trained to administer it. Glucagon is a hormone that causes the liver to release its stored glucose, providing a rapid boost to blood sugar levels. Even after administering glucagon, emergency medical services should still be contacted to ensure professional follow-up care.
Once the blood sugar is stabilized, whether through oral sugar or emergency glucagon, the person should eat a small snack that includes both carbohydrates and protein. This follow-up measure is necessary to replenish the liver’s glucose stores and sustain the corrected blood sugar level, preventing a subsequent drop after the immediate sugar source has been metabolized.