Blood sugar emergencies require immediate attention. When glucose levels fall too low or climb too high, the body’s systems can quickly become overwhelmed, leading to confusion, unconsciousness, or other severe complications. Recognizing the specific signs that indicate a medical emergency is important for anyone managing diabetes or caring for someone who does. This guide outlines the thresholds and symptoms that necessitate a trip to the emergency room for stabilization.
When Low Blood Sugar Becomes an Emergency
A severe drop in blood glucose, known as hypoglycemia, can rapidly become a medical crisis. While a blood sugar level below 70 mg/dL is considered low, the threshold for an emergency is 54 mg/dL. This lower number indicates the point at which the brain begins to suffer from a lack of glucose.
The primary trigger for seeking emergency medical help is the inability to self-treat the low blood sugar. This happens if the person experiences confusion, severe drowsiness, or becomes unresponsive. If the individual cannot safely swallow a fast-acting carbohydrate like juice or glucose tablets, immediate intervention is necessary.
Symptoms of severe hypoglycemia are primarily neurological. These signs include seizures, profound disorientation, or loss of consciousness. If a person who is unconscious or having a seizure does not receive a glucagon injection or nasal spray immediately, or does not respond to treatment within 15 minutes, emergency services must be called.
Recognizing the Danger of Severe High Blood Sugar
Severe high blood sugar (hyperglycemia) represents a medical emergency when it leads to life-threatening complications. A blood glucose level persistently above 300 mg/dL, or above 400 mg/dL, is a warning sign. However, the physical symptoms of ensuing complications are the indicators for an emergency room visit.
Diabetic Ketoacidosis (DKA)
One major complication is Diabetic Ketoacidosis (DKA), which is more common in Type 1 diabetes. DKA occurs when the body burns fat for fuel, producing acidic substances called ketones that build up in the blood. Symptoms include intense thirst, frequent urination, abdominal pain, nausea, and persistent vomiting.
A strong, fruity odor on the breath, caused by the exhalation of acetone, is a distinct sign of DKA. Another indicator is Kussmaul breathing, which is deep, rapid, and labored as the body attempts to reduce blood acidity. If a person with high blood sugar is vomiting or tests positive for moderate to large amounts of ketones, they require emergency transport.
Hyperosmolar Hyperglycemic State (HHS)
The other major complication is Hyperosmolar Hyperglycemic State (HHS), often seen in Type 2 diabetes. HHS is characterized by extremely high blood sugar levels and severe dehydration without significant ketone production. Symptoms often develop slowly and include extreme thirst, lethargy, and profound confusion, which can progress to coma.
Immediate Actions to Take While Waiting for Help
While waiting for assistance, certain actions must be taken immediately. Call 911 or local emergency services and clearly state that the person is experiencing a diabetic emergency. The person should never drive themselves to the hospital.
If the emergency is severe low blood sugar and the person is unconscious or unable to swallow, a caregiver should administer an emergency glucagon injection or nasal spray. Glucagon prompts the liver to release stored glucose. The person should be turned onto their side to prevent choking if they vomit, and never attempt to force food or liquid into the mouth of an unconscious person.
For severe high blood sugar, monitor the person closely and, if possible, check for ketones using a testing kit. If the person is conscious and not vomiting, encourage them to drink water to combat dehydration. Continue monitoring the person’s consciousness and blood sugar, providing this information to the emergency medical team upon arrival.
What Happens When You Arrive at the Emergency Room
Emergency room treatment focuses on stabilizing the blood sugar crisis. For severe hypoglycemia, the medical team immediately administers intravenous (IV) dextrose, typically D50W, to quickly raise the blood glucose level. After the initial dose, a continuous infusion of a weaker sugar solution, such as D10W, is started to maintain a safe glucose range and prevent the blood sugar from dropping again.
For DKA or HHS, the treatment focuses on three main goals: fluid replacement, insulin therapy, and electrolyte correction. Large volumes of IV fluids, usually a saline solution, are given first to correct the severe dehydration common to both conditions. Next, a continuous IV insulin drip is administered to gradually lower blood sugar and stop the production of ketones.
The patient’s potassium and other electrolyte levels are constantly monitored and replaced as needed throughout this process. Monitoring is important because insulin administration can cause potassium levels to drop low. Stabilization involves resolving the acidosis and ketosis in DKA or the extreme dehydration in HHS before transitioning the patient to standard diabetes management.