A diabetic emergency is a life-threatening situation caused by an extreme imbalance in blood glucose levels. Immediate intervention is required to prevent severe complications like seizures, coma, or permanent organ damage. Understanding the distinct symptoms and how to respond is necessary for anyone managing diabetes or caring for someone who does. This guidance provides clear, actionable steps for responding effectively to these urgent medical events.
Identifying the Two Main Crises
The two primary diabetic emergencies involve either dangerously low or extremely high blood sugar, each presenting unique signs. Severe hypoglycemia, or low blood sugar, occurs when glucose drops, depriving the brain of its main energy source. Symptoms manifest quickly and include intense trembling, profuse sweating, and a sudden, pale or clammy appearance.
As the condition worsens, mental and neurological functions are affected, leading to confusion, slurred speech, sudden mood changes, or an inability to cooperate. This severe state requires assistance, as the individual is unable to help themselves. Conversely, a severe hyperglycemic crisis, which can lead to Diabetic Ketoacidosis (DKA), develops more slowly, sometimes over many hours.
High blood sugar symptoms include excessive thirst and frequent urination, resulting from the body attempting to flush out excess glucose. When the body burns fat for fuel due to lack of effective insulin, it produces acidic ketones, leading to nausea, vomiting, and abdominal pain. A distinct, sweet or fruity odor on the breath, along with deep, rapid breathing (Kussmaul respirations), signals the presence of DKA and requires immediate attention.
Emergency Protocol for Severe Hypoglycemia
When a person is conscious but experiencing low blood sugar symptoms, they should immediately consume a fast-acting carbohydrate source containing 15 grams of sugar. Examples include a small glass of juice or soda, or four glucose tablets. Blood sugar should be checked after 15 minutes; this “Rule of 15” is repeated until the sugar level rises and symptoms improve.
If the individual is confused, unresponsive, or unable to swallow, administering food or drink by mouth must be avoided to prevent choking. The immediate action is to administer an emergency glucagon injection or nasal spray, if available, and call emergency services. Glucagon is a hormone that prompts the liver to release stored glucose into the bloodstream, rapidly elevating blood sugar levels.
After administering glucagon, the person should be gently rolled onto their side, as vomiting is a common side effect. The treatment should start working within 10 to 15 minutes, and the person should regain consciousness. If the person has not responded within 10 minutes, or if glucagon is unavailable, emergency medical personnel must provide intravenous glucose (dextrose) to reverse the crisis.
Emergency Protocol for Severe Hyperglycemia and DKA
A severe hyperglycemic state, especially one progressing to DKA, requires medical intervention and cannot be resolved with at-home insulin adjustments alone. The initial step for a conscious individual with very high blood sugar (often above 250 mg/dL) is to test for ketones in the urine or blood. The presence of moderate to high ketones indicates the body is producing toxic levels of acid and is entering a state of crisis.
If the person is experiencing persistent vomiting, has an altered mental state, or if ketones are present and not decreasing after an initial insulin dose, emergency medical help must be sought. The patient will require intravenous fluids, electrolyte replacement, and monitored insulin therapy in a hospital setting to resolve the acidosis and dehydration.
While waiting for help, the conscious person should drink sugar-free fluids, such as water, if they are able to keep them down. Maintaining hydration helps correct the significant fluid loss that accompanies severe hyperglycemia and DKA. However, if the person is nauseated, vomiting, or confused, no fluids should be given by mouth, as this risks aspiration.
Essential Emergency Kit Preparation
Proactive preparation begins with assembling a specific emergency kit. This kit should contain fast-acting glucose sources, such as glucose tablets or gel, effective for treating mild to moderate low blood sugar events. An unexpired emergency glucagon kit or pen must also be included.
The kit should house several essential items:
- Blood glucose testing supplies.
- A fresh supply of ketone test strips (blood ketone testing is preferred).
- Necessary medications like extra insulin and syringes or pen needles.
- A list of emergency contact numbers, including the treating physician and family members.
This information should be stored in a waterproof container alongside the medical supplies.
Every person with diabetes should wear or carry a form of medical identification, such as a bracelet or wallet card. This identification communicates the diagnosis to first responders, allowing them to initiate the correct treatment protocol immediately. Regularly checking and replacing expired items ensures the kit remains reliable during a crisis.