A diabetic emergencies occurs when blood sugar levels become dangerously low (hypoglycemia) or high (hyperglycemia), impairing brain and organ function and potentially leading to seizures, coma, or cardiac arrest
Types of Diabetic Emergencies
| Emergency Type | Medical Term | Typical Blood Glucose Level | Onset |
|---|---|---|---|
| Low blood sugar | Hypoglycemia | < 70 mg/dL (3.9 mmol/L) | Rapid (minutes) |
| High blood sugar | Hyperglycemia | > 250 mg/dL (13.9 mmol/L) | Gradual (hours–days) |
Low Blood Sugar Levels
Symptoms of low blood sugar (hypoglycemia) include the following:
- Rapid onset of confusion, irritability, or combativeness
- Hunger
- Rapid pulse rate
- Shallow breathing
- Pale, clammy skin
- Loss of co-ordination, tremors, slurred speech
- Generalized weakness
- Headache, dizziness
- Seizures
High Blood Sugar Levels
Symptoms of high blood sugar (hyperglycemia) include the following:
- Slow onset of confusion and irritability
- Hunger, thirst and frequent urination
- Headache
- Blurred vision
- Nausea and vomiting
- Abdominal pain
- Fruity smelling breath
Diabetic emergencies occur when a person’s blood sugar levels become dangerously low (hypoglycemia) or excessively high (hyperglycemia), and can quickly lead to serious complications if not addressed promptly. First aid in these situations is critical for stabilizing the person until professional help is available. Here’s a comprehensive guide on how to recognize and manage a diabetic emergency
Signs & Symptoms of diabetic emergencies
- Sweating, clammy or pale skin; trembling, shakiness
- Hunger, nausea, dizziness, headache
- Confusion, irritability, slurred speech, blurred vision
- Rapid or weak pulse, shallow or rapid breathing
- Fruity breath odor, excessive thirst, frequent urination (hyperglycemia)
- Seizures, loss of consciousness, or coma (severe cases)
When to Call Emergency Services
Activate EMS immediately if the person:
- Has a seizure, loses consciousness, or can’t swallow safely
- Shows signs of shock (weak pulse, pale skin, confusion)
- Does not improve after two rounds of hypoglycemia treatment
- Exhibits dehydration, vomiting, or suspicion of diabetic ketoacidosis (DKA)
First Aid for Diabetic Emergencies
1. Assess the Situation
- Check for Warning Signs: Look for indications that a diabetic emergency is underway. In hypoglycemia, these may include shakiness, sweating, chills, irritability, confusion, or even loss of consciousness. In hyperglycemia, signs include excessive thirst, frequent urination, blurred vision, fatigue, and, in severe cases, nausea, vomiting, or breath that smells fruity.
- Obtain Information: If the person is aware of their condition, ask if they have diabetes and if they carry any supplies such as glucose tablets, a glucose gel, or a glucagon kit. A medical alert bracelet or jewelry can also provide valuable information about their condition.
- Ensure Safety: Make sure you’re in a safe environment and that the person is in a position where you can provide aid without causing harm.
- Call for Help: If the person is unresponsive, severely confused, or exhibiting signs of a serious emergency (like seizures or loss of consciousness), call emergency services immediately (911 or your local emergency number).
2. Managing Hypoglycemia (Low Blood Sugar)
Hypoglycemia occurs when blood sugar levels drop too low, often below 70 mg/dL. It can arise from missed meals, increased physical activity, excess medication, or other factors.
- If the Person Is Responsive:
- Provide Fast-Acting Carbohydrates: Offer a source of quick sugar. Good options include:
- Glucose tablets (follow the dose recommended on the package)
- About 4 ounces (half a cup) of regular (non-diet) soda or fruit juice
- A tablespoon of honey or sugar These sources generally contain about 15–20 grams of carbohydrate.
- Monitor and Reassess: Wait about 15 minutes after giving the sugar. If the person’s symptoms do not improve, repeat the carbohydrate dose. Once the individual feels better, they should have a small meal or snack to stabilize blood sugar levels further.
- Provide Fast-Acting Carbohydrates: Offer a source of quick sugar. Good options include:
- If the Person Is Unresponsive:
- Do Not Attempt Oral Intake: Do not try to give fluids or food by mouth.
- Administer Glucagon (If Available): If the person has been prescribed a glucagon injection and you are trained to use it, follow the kit’s instructions to help raise their blood sugar.
- Call Emergency Services: Immediate professional medical help is necessary.
3. Managing Hyperglycemia (High Blood Sugar)
Hyperglycemia occurs when blood sugar levels are too high and can progress to a dangerous condition called diabetic ketoacidosis if not treated promptly.
- If the Person Is Conscious and Alert:
- Encourage Adherence to Their Diabetes Plan: Advise them to follow their prescribed treatment, which may include taking additional insulin or other medications as directed by their healthcare provider.
- Hydration: Encourage drinking water or non-sugary fluids to prevent dehydration.
- Monitor the Situation: Keep checking on their condition. If symptoms worsen or if they become unresponsive, call emergency services.
- If Severe or Unresponsive:
- Call Emergency Services Immediately: Severe hyperglycemia with signs of confusion, rapid breathing, or a fruity odor on the breath requires prompt medical attention.
- Do Not Administer Medications Without Guidance: Unless you are specifically trained and authorized, avoid giving insulin or any other medication. Professional assessment is crucial.
4. General Points for Both Emergencies
- When in Doubt, Provide Sugar (for Hypoglycemia): If you’re unsure whether the person’s blood sugar is low or high, it is generally safer to give some sugar if the person is conscious. A short delay in correcting hypoglycemia can have immediate life-threatening effects, and a small amount of sugar is unlikely to cause serious harm if blood sugar is actually high.
- Monitor Vital Signs: Always observe the person’s responsiveness, breathing, and pulse until professional help arrives. Documenting the time when symptoms started and when you administered any aid can provide critical information for healthcare providers.
- Follow-Up: Even if the person appears to recover after your intervention, they should be evaluated by a healthcare professional. Diabetic emergencies might signal the need for an adjustment in the person’s longtime diabetes management plan.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Offer measured fast-acting carbs for hypoglycemia | Give insulin or diabetes medication during first aid |
| Reassess after 15 minutes and repeat treatment if needed | Leave the person alone or allow them to drive |
| Place unresponsive individuals in the recovery position | Force food or drink into the mouth of an unresponsive person |
| Assist with glucagon injection when trained and indicated | Delay calling EMS for prolonged seizures or shock |
| Follow with a balanced snack after symptom resolution | Rely on diet drinks or home remedies without sugar content |
Diabetic Emergency Kit
Being prepared for a diabetic emergency could save your life or the life of someone you care for. Be sure to have these supplies available, as needed, and that everyone in your household knows where to find them.
What should you carry in a diabetes emergency kit?
- If you inject insulin, be sure you have a fresh supply on hand at all times and check expiration dates. Designate a place in your home to store your insulin and make sure all other household members know where it is and how to inject it.
- Items for treating low blood sugar, such as juice, regular soda, or glucose tablets.
- A glucagon kit, in case you or a person you care for can’t consume glucose to treat low blood sugar. If you care for a person with diabetes, know how to use it.
- A ketone test kit.
- If you have diabetes, wear a medical alert bracelet or necklace so that emergency responders or ER doctors will know you have the condition.
- Complete information about the medications you take. Apps are available that allow you to carry your medical information on your smartphone.
REFERENCES
- J. Furst. First Aid for Diabetic Emergencies. First Aid for Free. Updated February 27, 2023. https://www.firstaidforfree.com/first-aid-for-diabetic-emergencies/
- Adeyinka, A. Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome), StatPearls Publishing, 2018.
- Redcross, Diabetic Emergencies: How To Help, https://www.redcross.org/take-a-class/resources/learn-first-aid/diabetic-emergencies
- Bergmann KR, Nickel A, Hall M, Cutler G, Abuzzahab MJ, Bretscher B, Lammers S, Watson D, Hester GZ. Association of Neighborhood Resources and Race and Ethnicity With Readmissions for Diabetic Ketoacidosis at US Children’s Hospitals. JAMA Netw Open. 2022 May 2;5(5):e2210456. doi: 10.1001/jamanetworkopen.2022.10456. PMID: 35511179; PMCID: PMC9073568.
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