What to do in diabetic emergencies

According to the Centers for Disease Control and Prevention (CDC), around 12.6 percent of the population in the United States have diabetes, with or without a diagnosis.

In the past, diabetes was often fatal, but recent progress in science and medication mean that most people with diabetes can now enjoy a normal lifespan.

However, the CDC state that diabetes, or complications related to it, is still the seventh most frequent form of death in the U.S., and it was responsible for nearly 25 deaths in every 100,000 in 2016.

Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), greater susceptibility to infections, and a range of complications all increase the risk.

Knowing the signs and being able to respond promptly may save lives. Read on to find out how and why diabetes can become dangerous, and what to do about it.

Any sudden, unexplained symptom warrants a call to the doctor.

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Both type 1 and type 2 diabetes prevent the body from managing blood sugar levels effectively.

In type 1 diabetes, the immune system destroys the cells that produce insulin. Type 2 diabetes reduces the body’s ability to respond to insulin. Consequently, the body does not produce enough insulin to manage the glucose in the body.

Most diabetic emergencies relate to disruptions in a person’s blood sugar levels, but complications relating to diabetes can also lead to problems.

Here are some of the most common emergencies that can arise, their warning signs, and what to do.

Hypoglycemia happens when blood sugar levels are too low, usually below 70 milligrams per deciliter (mg/dl).

Without treatment, such low levels of blood sugar can lead to seizures and become life-threatening. It is a medical emergency. However, it is easy to put right in the short-term as long as a person recognizes the signs.

Hypoglycemia can occur for many reasons, but, in diabetes, it usually stems from the use of insulin or other medications that control blood sugar.

Blood sugar levels may drop dangerously low when a person:

• takes more insulin than they need for their current food intake or exercise levels
• consumes too much alcohol
• misses or delays meals
• does more exercise than they expected to do

Early warning signs

The warning signs of hypoglycemia include:

• confusion, dizziness, and nausea
• feeling hungry
• feeling shaky, nervous, irritable or anxious
• sweating, chills, and pale, clammy skin
• rapid heartbeat
• weakness and tiredness
• tingling in the mouth area
• headaches
• seizures
• coma or loss of consciousness
• weight loss if hypoglycemia persists

If a person tests their blood sugar levels when they experience these symptoms, they may find that they are below 70 mg/dl.

Action to take

If the symptoms appear suddenly, the person should take a high-carb snack to resolve them, such as:

• a glucose tablet
• a sweet juice
• a candy
• a sugar lump

The American Diabetes Association (ADA) recommend the following action:

1. Take 15 grams (g) of carbohydrate and wait 15 minutes before testing blood sugar levels.
2. If levels are still below 70 mg/dl, take another 15 g of carbs, wait, and test again.
3. When glucose levels are above 70 mg/dl, eat a meal.
4. If symptoms persist, seek medical help for any underlying condition.

If the person is conscious but unable to eat, someone who is with them should put a little honey or other sweet syrup inside their cheek and monitor their condition.

If they lose consciousness, any bystander should call 911 and ask for emergency medical help.

If a person experience regular hypoglycemia despite following the treatment plan, or if changes in blood sugar level occur suddenly in response to a medication change, they should see a doctor.

Hyperglycemia is when blood sugar levels are too high because insulin is not present or the body is not responding to the insulin that is present.

It can happen if a person with diabetes does not receive treatment.

Early warning signs

The person may notice:

• increased thirst
• the need to urinate more frequently
• headaches
• blurry vision
• fatigue

Tests will show high levels of sugar in the blood and urine.

Action to take

In mild cases, ways of resolving this include:

• exercising more
• eating less
• changing the dose of insulin or other medication

However, very high blood sugar levels can lead to life-threatening complications, such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

If symptoms worsen or if a person experiences difficulty breathing or has a very dry mouth or a fruity smell on their breath, they should see a doctor as soon as possible.

Click here to find out more about hyperglycemia.

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin to allow glucose to enter the cells properly.

The cells do not have enough glucose to use for energy, so, instead, the body breaks down fat for fuel.

When this happens, the body produces substances known as ketones. High levels of ketones are toxic because they can raise the acidity levels of the blood.

Reasons why DKA might happen include:

• low insulin levels, due to not taking insulin or because another factor stops the insulin from working correctly
• not eating enough
• having an insulin reaction

People with both type 1 and type 2 diabetes can develop DKA.

Warning signs

The warning signs include:

• feeling thirsty or having a dry mouth
• frequent urination
• fatigue
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• difficulty focusing
• confusion
• difficulty breathing
• a fruity smell on the breath

Action to take

If a ketone test shows that ketones are present and a blood glucose test shows that a person’s blood sugar levels are 240 m/dl or above, the ADA advise them to see a doctor.

Anyone with these symptoms should seek medical help as soon as possible, as DKA can become a medical emergency.

People can buy testing kits for ketones and blood sugar levels online.

According to the American Academy of Family Physicians (AAFP), hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high, usually above 600 mg/dl.

This may happen with or without DKA, and it can be life-threatening.

People with poorly controlled type 2 diabetes are more prone to HHS, but people without diabetes — or a without diagnosis of diabetes — might experience it.

According to the AAFP, the following factors may increase the risk:

• infections, including pneumonia, a urinary tract infection, and sepsis
• the use of some medications, including some psychiatric treatments and diuretics, which can lead to dehydration
• not following treatment for diabetes
• having undiagnosed diabetes
• misuse of some substances
• having another health condition, such as a heart attack, a stroke, or a pulmonary embolism (lung clot)

Some of these can also occur with diabetes and may be a complication of diabetes.

Early warning signs

Symptoms include:

• a dry mouth
• a weak and rapid pulse
• a low-grade fever (in adults)
• a headache, nausea, and vomiting (in children)
• seizures
• a loss of consciousness
• temporary partial paralysis

Blood tests may show that the person’s blood glucose level is above 600 mg/dl.

Action to take

If a person has these symptoms, they or someone else should seek medical help at once.

The person will require treatment in the hospital, which will include rehydration, the use of insulin, and any necessary treatment for an underlying cause.

Researchers note that the processes that occur with diabetes can also affect the immune system.

As a result, a person with diabetes will have a higher chance of developing an infection. When a person has diabetes, any symptoms and complications of an infection may be more severe and possibly life-threatening.

Common infections that can occur with diabetes include:

• skin infections that can lead to ulceration
• urinary tract infections, which may spread to the kidneys
• ear infections
• respiratory infections, including pneumonia and influenza
• gastrointestinal and liver infections
• gum disease

Minor infections can spread to deeper tissue, possibly leading to sepsis and other potentially life-threatening complications.

Factors that increase the risk include:

• a recent injury or illness
• an open wound
• exposure to pathogens, such as viruses, fungus, or bacteria

People with poorly controlled diabetes and those with other complications should take care to:

• avoid infections where possible, for example, by having any vaccinations that the doctor recommends
• checking the skin, and especially the feet, for wounds
• getting early treatment for any wound or possible infection

Warning signs and action

If a person experiences a fever, pain, and swelling in any part of their body, they should seek medical advice.

An infection can become rapidly become serious when a person has diabetes.

Diabetes can harm almost every system in the body and increase the risk of many other diseases.

People with diabetes can experience a range of problems, including:

• cardiovascular disease, which may lead to a heart attack or a stroke
• poor circulation that leads to ulcers in the legs
• vision loss
• kidney failure
• obesity

Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications.

A diabetic emergency happens when symptoms relating to diabetes overwhelm the body.

At this point, home treatment is unlikely to help, and delaying medical care could cause permanent damage or death.

Some of the signs that can indicate a serious problem include:

• chest pain that radiates down the arm
• difficulty breathing
• a fever
• a severe headache and weakness in one side of the body
• seizures
• loss of consciousness

If there are signs of an emergency, the person should go to the emergency room, or they or someone with them should call 911 immediately.

Without rapid help, some diabetic emergencies can be life-threatening.

It is not always possible to prevent an emergency, but being able to recognize the signs can improve the chances of early treatment and a full recovery.

Strategies that can help to reduce the risk of an emergency include:

Following the treatment plan: Use medications as a doctor prescribes and keep in touch with the healthcare team. If a person cannot remember whether or not they took their last dose of drugs, they should ask a doctor before taking a further dose. This can help to prevent hypoglycemia. Anyone who notices a change in their symptoms should see a doctor.

Eating healthful, balanced, regular meals: People who use insulin or other medications that lower blood glucose should ask their doctor about what foods to eat, how much, and when, in order to maintain stable blood sugar levels. Small, frequent meals are better than fewer larger meals.

Limiting alcohol and sugary drinks: These drinks contain carbs, which can raise blood sugar and contribute to obesity. Alcohol consumption can also increase the risk of other health conditions.

Treating infections early: Diabetes can compromise the immune system and the body’s organs, making it easier for infections to develop. Prompt treatment can prevent minor problems from becoming more serious.

Exercising regularly: Exercise helps the body control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.

No specific medication or procedure can stop a diabetic emergency once it occurs, but emergency planning can increase the chances of getting prompt help.

People with diabetes should:

• let their friends know they have diabetes
• wear a medical ID so that people will know what to do in an emergency
• keep a mobile phone charged and ready to contact emergency responders
• know who to call with questions about diabetes emergencies

Diabetes is a serious and complex condition, and an emergency can arise for various reasons.

Managing the condition through medication and a healthful lifestyle, ensuring that others know the person has diabetes, and learning as much as possible about diabetes and its complications can reduce the risk of an emergency arising.