People with diabetes can run into trouble if their levels of blood sugar and insulin are out of balance. Usually, they can take steps to correct what's going on and stop the symptoms.
But sometimes, they won't be able to help themselves, and you may need to step in to save their life. If you know someone who has diabetes, it may be worth having a conversation with them about what to do in an emergency.
What Is a Diabetic Emergency?
A diabetic emergency occurs when someone's blood sugar levels become dangerously high or low, which can cause severe symptoms and be fatal. There are two types of diabetic emergencies:
- Hypoglycemia, which happens if your blood sugar level drops very low
- Hyperglycemia, which happens if your blood sugar level rises very high
Extreme spikes or dips in blood sugar can cause major changes in how your body functions and require prompt medical attention.
Insulin Shock
This term is sometimes used to describe a diabetic emergency that happens if you develop severe hypoglycemia, or very low blood sugar. The term "insulin shock" is somewhat misleading because although it occurs most often in people who use insulin, you can also develop this problem if you use other diabetes drugs, such as sulfonylureas. You may experience insulin shock if your blood sugar drops below 60 milligrams per deciliter.
What is hypoglycemia unawareness?
Some people don't know when their blood sugar is low. That's called hypoglycemia unawareness. They might have early signs, but not every time. Instead, they can get severe hypoglycemia without warning. Unawareness is more common in people who've had diabetes a long time.
Why is insulin shock a diabetic emergency?
Insulin shock is a diabetic emergency because it can interfere with your ability to think clearly and even cause you to lose consciousness. That means you will be unable to treat your falling blood sugar and will require someone to help you. If no one is available to treat your severely low blood sugar, you could die.
Insulin shock causes
You could develop insulin shock if you use insulin or sulfonylurea medication and you:
- Skip a meal
- Exercise more than usual
- Drink alcohol without eating
- Take too much insulin, use the wrong type of insulin, or inject insulin improperly
- Take the wrong amount of diabetes medicine
Insulin shock symptoms
Most people with diabetes can tell when their blood sugar is low because of early warning signs like shakiness and hunger. If you don't treat low blood sugar and it continues to sink, you may develop any of these symptoms:
- Confusion
- Blurred vision
- Severe weakness
- Seizures
- Passing out
- Coma
How to help someone with insulin shock
If you think someone is experiencing insulin shock, ask them to check their blood sugar. Help them get what they need to follow the 15/15 rule: eat 15 grams of fast-acting carbs (three to four glucose tablets or gels, four ounces of fruit juice or regular soda, or a tablespoon of honey or sugar) and wait 15 minutes. If they don't feel better, they should have more carbs and test their blood sugar again.
When someone passes out from hypoglycemia, it's a medical emergency. Don't try to give them food or liquid — they could choke. You, or someone who knows how, should give them a glucagon shot — not insulin! — to raise their blood sugar to a safer level. Then call 911.
An unconscious person will usually wake up within 15 minutes after getting the glucagon. After they do and if they can drink, give them sips of regular soda or fruit juice while you're waiting for help to arrive. They need to treat hypoglycemia as soon as possible to stop it from getting severe, which can lead to a seizure or a diabetic coma.
Diabetic Ketoacidosis (DKA)
DKA is a diabetic emergency that happens when you don't have enough insulin and your liver has to break down fat into substances called ketones for energy. This can result in a change in blood chemistry that causes unpleasant symptoms and even be fatal. DKA is the most common complication of type 1 diabetes, but it's also possible with type 2 diabetes and gestational diabetes, the kind you get while pregnant.
Why is DKA a diabetic emergency?
It's normal for your body to burn fat to use as energy, which produces ketones. This phenomenon is the basis of the so-called "keto diet." However, in DKA, your body lacks enough insulin to break down its preferred source of energy: glucose. Instead, it metabolizes large amounts of fat, which produces high levels of ketones. That can make your blood too acidic, which is toxic and can make you seriously ill. DKA is a potentially life-threatening complication of diabetes. In fact, DKA is the leading cause of death among children with diabetes. It's also the number one reason kids with diabetes need to be hospitalized.
DKA causes
Many people who are diagnosed with type 1 diabetes don't know they have the disease until they develop symptoms of DKA and seek treatment. Some common causes of DKA include:
Problems with insulin. If you inject insulin, forgetting a dose or using expired insulin can cause DKA. If you have an insulin pump, the condition can occur if it malfunctions or runs out of medicine.
Getting sick. Some illnesses and infections can trigger DKA.
You're stressed out. Emotional stress and living through taxing experiences such as having a heart attack or stroke can cause you to release hormones that interfere with insulin, so your body's demand goes up.
Certain medications. Some drugs can cause DKA. Ask your doctor if any medications you use could be a problem.
Pancreatitis. This condition can reduce insulin levels.
DKA symptoms
The early symptoms of DKA are:
- Extreme thirst
- Dry mouth
- Peeing often
More serious symptoms are:
- Tired all the time or feeling weak
- Dry or flushed skin
- Breath that smells fruity
- Nausea, vomiting, or belly pain
- Trouble breathing
- Feeling woozy, confused, or passing out
How to help someone with DKA
If someone has early signs of DKA, encourage them to test their pee with a ketone test kit. If their ketones are high, they should call their doctor. If they have serious signs, take them to the emergency room or urgent care right away.
Hyperosmolar hyperglycemic syndrome (HHS)
HHS is a diabetic emergency that occurs when your blood sugar soars over 600 milligrams per deciliter and remains at a very high level for a long period. That can result in severe dehydration and changes in the blood, which can be life-threatening.
While HHS has some of the same symptoms as DKA, these are two distinct conditions with important differences. For example, HHS most commonly affects people with type 2 diabetes, while DKA happens more often in people with type 1 diabetes. Also, HHS develops slowly, over days or even weeks, while DKA comes on quickly, usually over the course of a single day. And HHS doesn't cause your body to develop a potentially toxic level of substances called ketones, which happens in DKA.
Doctors used to have other names for HHS, which you may hear used on occasion. They include:
- Non-ketotic hyperglycemic coma
- Hyperosmolar hyperglycemic non-ketotic syndrome
- Hyperosmolar non-ketotic coma
Why is HHS a diabetic emergency?
HHS is a life-threatening condition that can cause seizures and organ failure. If it's not treated in time, HHS can induce coma and be fatal.
HHS causes
One of the most common causes of HHS is poorly controlled type 2 diabetes — if you take your medication as recommended and keep your blood sugar under control, your risks of this condition are very low. Some other common triggers for HHS include:
- Infections, such as pneumonia, urinary tract infections, and sepsis
- Certain medications, including thiazide diuretics, beta-blockers, glucocorticoids, and some types of antipsychotics
- Heart attacks, strokes, angina pectoris, and other serious cardiovascular problems
HHS symptoms
Common symptoms of HHS include:
- Dry mouth
- Cool hands and feet
- Warm skin, no sweat
- Fast heart rate
- Fever over 101 F
- Constant thirst
- Peeing often
- Dark pee
- Nausea, vomiting, or stomachache
- Confusion or hallucinations
- Slurred speech
- Weakness on one side of the body
- Loss of consciousness
- Vision problems
How to help someone with HHS
Call their doctor, then get them to the emergency room or urgent care.
Diabetic Coma
A diabetic coma is a dangerous condition that can happen if your blood sugar becomes very high (hyperglycemia) or very low (hypoglycemia) and remains untreated. A coma is a prolonged period of unconsciousness. If you're in a coma, you don't respond to any stimulation, such as being touched or spoken to. Fortunately, getting prompt treatment can reverse a diabetic coma.
Why is diabetic coma an emergency?
Diabetic coma is a life-threatening condition. The causes of diabetic coma can result in potentially fatal poisoning of the blood and organ failure. If not treated promptly, diabetic coma can result in permanent brain damage and death.
Diabetic coma causes
The three causes of diabetic coma are:
- DKA, in which your body can't burn sugar for energy, causing glucose levels to rise and a buildup of substances called ketones, which can be toxic
- HHS, which causes ultrahigh blood sugar levels
- Severe hypoglycemia, or extremely low blood sugar
Diabetic coma symptoms
You may suspect diabetic coma if a person who has diabetes is unconscious and you can't wake them with any form of stimulation, such as shouting or poking.
How to help someone in a diabetic coma
If you suspect that someone has gone into a diabetic coma, call 911 or the emergency services number in your area immediately. The operator may give you instructions on what to do. Even though low blood sugar may be the cause, don't try to remedy the problem by giving the person glucose in any form (such as juice), which could cause choking. Turn the person on their side in case they vomit.
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.
Takeaways
Your blood sugar levels fluctuate throughout the day, but if they fall too low or rise too high, you could experience a diabetic emergency. If you have diabetes, or someone you know has the condition, knowing how to recognize and respond to a diabetic emergency can be a lifesaver. Following the diabetes management plan you created with your doctor can help you avoid diabetic emergencies.
Diabetic Emergency FAQs
What are the types of diabetic emergencies?
There are several diabetic emergencies, but all occur for one of two reasons: either your blood sugar falls too low or rises too high and remains at that extreme level.
When should someone with diabetes go to the ER?
If you have diabetes and develop symptoms that you can't explain, go to the nearest ER or have someone bring you. Some typical symptoms of a diabetes emergency include extreme thirst and dry mouth, frequent peeing, fruity-smelling breath, and rapid heartbeat.
What should I do if a person with diabetes is unresponsive?
Call 911 and follow the operator's instructions.
What happens during diabetic shock?
Diabetic shock is a term sometimes used to describe the condition that occurs when your blood sugar drops very low (below 60 milligrams per deciliter). Because your cells need blood sugar to function properly, diabetic shock can cause severe symptoms, such as seizures, extreme weakness, confusion, and coma.
What is someone's sugar level during a diabetic coma?
Blood sugar levels usually exceed 600 milligrams per deciliter in hyperosmolar hyperglycemia syndrome, which can cause diabetic coma. Untreated low blood sugar (below 60 milligrams per deciliter) can also put you at a risk of diabetic coma.
