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Diabetes Awareness Month: Recognizing a Diabetic Emergency Before It’s Too Late

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A person with diabetes may seem fine one moment and become confused, weak, or seriously ill the next. Sometimes, the first sign is easy to overlook: unusual sweating, sudden irritability, extreme thirst, or nausea that doesn't go away.

Knowing what to watch for can make a real difference when someone with diabetes needs help. Blood sugar can drop too low or rise to dangerously high levels. Both situations can become medical emergencies, and the warning signs aren't always what people expect.

During Diabetes Awareness Month, we're taking a closer look at how to recognize a diabetic emergency, what can trigger one, and when it's time to seek medical attention. Whether you're living with diabetes, caring for a family member, or simply want to know how to help someone nearby, understanding these signs can help you respond when it matters.

What Happens During a Diabetic Emergency?

Diabetes affects how the body uses glucose, commonly called blood sugar, for energy. Insulin is a hormone that helps move glucose from the bloodstream into the body's cells. When the body doesn't produce enough insulin or can't use it properly, blood sugar levels can rise. Diabetes medications, meals, physical activity, and other health factors can also cause blood sugar to drop too low.

A diabetic emergency can happen when blood sugar moves outside a safe range or when a serious diabetes-related complication affects the body.

Two common blood sugar problems to recognize are:

  • Hypoglycemia (low blood sugar). Blood sugar drops below the level the body needs to work properly. For many people with diabetes, a reading below 70 mg/dL is considered low. A reading below 54 mg/dL is considered significantly low and requires immediate attention.
  • Hyperglycemia (high blood sugar). Blood sugar rises above the person's target range. When levels become very high, serious complications such as diabetic ketoacidosis (DKA) can develop.

These problems can affect people with type 1 or type 2 diabetes, although the risks and circumstances may differ. In some cases, a serious blood sugar problem may even be the first sign of diabetes in someone who hasn't been diagnosed.

Signs of Low Blood Sugar: When Symptoms Appear Suddenly

Low blood sugar can develop quickly. It may happen when someone takes more insulin or diabetes medication than needed, skips a meal, eats less than usual, or gets more physical activity than expected. Drinking alcohol can also contribute to low blood sugar.

The first symptoms may seem minor, but they can become more serious if blood sugar continues to fall.

Common Symptoms of Hypoglycemia

Watch for changes such as:

  • Shaking or trembling
  • Sweating, even when the person isn't hot
  • Sudden hunger
  • Dizziness or lightheadedness
  • Headache
  • Fast heartbeat
  • Irritability, anxiety, or unusual behavior
  • Blurred vision or difficulty concentrating

Someone experiencing low blood sugar may describe feeling shaky, weak, or suddenly unlike themselves. A family member might notice that they're unusually quiet, confused, or having trouble following a conversation.

When Low Blood Sugar Becomes an Emergency

As blood sugar drops further, the brain may not get the glucose it needs to work properly. The person may become severely confused, have difficulty walking, lose consciousness, or experience a seizure.

At this point, they may not be able to recognize what's happening or treat the problem themselves.

Call 911 if someone with suspected low blood sugar has a seizure, loses consciousness, or cannot swallow safely. Do not give them food, juice, candy, or other liquids by mouth because they could choke. If they have prescribed glucagon and someone present knows how to use it, follow the medication instructions while emergency help is on the way.

If the person is awake, alert, and able to swallow safely, their diabetes care plan may recommend fast-acting carbohydrates to raise their blood sugar. The CDC's 15-15 rule for low blood sugar recommends taking 15 grams of fast-acting carbohydrates, waiting 15 minutes, and checking blood sugar again. This process may be repeated if the reading remains below 70 mg/dL. Individual instructions may differ, particularly for children.

Even if symptoms improve, repeated or severe low blood sugar episodes should be discussed with the person's healthcare provider.

Signs of High Blood Sugar: When the Body Is Under Stress

High blood sugar doesn't always cause sudden, noticeable symptoms. It can develop over time, particularly when someone is sick, under stress, dehydrated, or having difficulty following their usual diabetes treatment plan.

Early signs may include:

  • Increased thirst or a dry mouth
  • Frequent urination
  • Blurred vision
  • Unusual fatigue
  • Headaches
  • Difficulty concentrating

A person might assume they're simply tired or haven't had enough water. But when these symptoms persist or become more noticeable, it's important to pay attention.

Very high blood sugar can lead to serious complications. Two conditions that require emergency medical attention are diabetic ketoacidosis and hyperosmolar hyperglycemic state.

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis, or DKA, happens when the body doesn't have enough insulin to use glucose for energy. Instead, it starts breaking down fat for fuel, producing substances called ketones. When too many ketones build up in the blood, they make the blood dangerously acidic.

DKA is more common in people with type 1 diabetes, but it can also affect people with type 2 diabetes.

Warning signs include:

  • Nausea and vomiting
  • Abdominal pain
  • Extreme thirst or dry mouth
  • Unusual tiredness or weakness
  • Fruity-smelling breath
  • Rapid or deep breathing
  • Confusion or difficulty concentrating

DKA can develop quickly, sometimes during an illness or after missed insulin doses. It may also be the first noticeable sign of diabetes in someone who hasn't been diagnosed.

DKA is a medical emergency. Seek emergency care if someone has symptoms such as repeated vomiting, abdominal pain, fruity-smelling breath, or difficulty breathing. DKA can sometimes develop even when blood sugar isn't extremely high, so a glucose reading alone cannot rule it out. Don't wait for every symptom to appear.

Hyperosmolar Hyperglycemic State (HHS)

Another serious complication is hyperosmolar hyperglycemic state, or HHS. It involves extremely high blood sugar levels. The kidneys try to remove excess sugar through urine, which can lead to significant fluid loss and severe dehydration.

HHS is more commonly associated with type 2 diabetes and often develops over several days.

Possible warning signs include:

  • Intense thirst and frequent urination
  • Severe dehydration
  • Weakness or extreme fatigue
  • Blurred vision
  • Confusion or unusual drowsiness
  • Seizures or loss of consciousness in severe cases

HHS requires immediate medical treatment. Severe dehydration and changes in alertness should not be monitored at home while waiting for improvement.

What Can Trigger a Diabetic Emergency?

Not every diabetic emergency happens because someone forgot to take medication or ate something they shouldn't have. Blood sugar can change for several reasons, including circumstances that are difficult to predict.

Common triggers include:

  • Illness or infection. The body's response to an infection can raise blood sugar, even when someone is eating less than usual.
  • Missed or incorrect medication doses. Taking too much insulin can cause low blood sugar, while not getting enough insulin can contribute to very high blood sugar and DKA.
  • Changes in meals. Skipping meals, eating less than expected, or changing how much carbohydrate someone eats can affect blood sugar.
  • Physical activity. Exercise can lower blood sugar during or after activity, sometimes several hours later.
  • Dehydration. Losing too much fluid can make high blood sugar harder to manage and contribute to serious complications.
  • Changes in routine. Travel, stress, changes in sleep, or a disrupted medication schedule can affect diabetes management.

Even someone who usually manages their diabetes well can experience unexpected changes in blood sugar. Understanding these potential triggers can help them recognize when their usual management plan may need attention.

What Should You Do If Someone May Be Having a Diabetic Emergency?

When someone shows signs of a possible diabetic emergency, try to stay calm and focus on their immediate safety. If they have diabetes, ask how they're feeling and whether they have a blood glucose meter or continuous glucose monitor (CGM), a device that tracks blood sugar throughout the day.

If it's safe and practical, checking their blood sugar may provide useful information. However, don't delay emergency care to get a reading if the person is seriously ill.

Here are some important steps:

  1. Watch for changes in behavior or alertness. Confusion, unusual drowsiness, difficulty speaking, or trouble walking can signal a serious problem.
  2. Check blood sugar if possible. If the person is alert and able to participate, follow their established diabetes care plan.
  3. Don't give anything by mouth if they cannot swallow safely. Food or liquids could cause choking or enter the lungs.
  4. Call 911 for severe symptoms. Seizures, unconsciousness, difficulty breathing, or significant changes in alertness require emergency assistance. Do not have the person drive themselves.
  5. Share relevant information with medical responders. If available, provide their diabetes medications, recent blood sugar readings, known medical conditions, and when the symptoms began.

A person doesn't need a confirmed diabetes diagnosis to experience a serious blood sugar emergency. If someone shows concerning symptoms, don't dismiss them simply because they haven't been diagnosed with diabetes.

When Should You Go to the Emergency Room?

Some symptoms call for immediate emergency evaluation, including:

  • Repeated vomiting or an inability to keep fluids down
  • Signs of diabetic ketoacidosis, including fruity-smelling breath, abdominal pain, or rapid breathing
  • Severe dehydration or extreme weakness
  • Confusion, unusual drowsiness, or difficulty staying alert
  • A seizure or loss of consciousness
  • Blood sugar levels that remain dangerously high or low despite following their prescribed treatment plan

Call 911 rather than driving if the person is unconscious, having a seizure, struggling to breathe, or otherwise unable to travel safely.

A blood sugar reading is only one part of the picture. DKA, for example, can sometimes develop without extremely high blood sugar. A person's symptoms and overall condition also matter.

How Advance ER Helps When Diabetes Symptoms Become Urgent

When someone may be experiencing a diabetic emergency, they may need immediate medical evaluation rather than waiting for a routine appointment.

At Advance ER, we provide emergency medical care at our freestanding emergency rooms in the Galleria Area and Park Cities. Both locations are open 24 hours a day, seven days a week.

Our facilities have onsite diagnostic services, including laboratory testing, X-rays, CT scans, and ultrasound. Our emergency physicians evaluate patients based on their symptoms, medical history, and test results to determine what medical care is appropriate.

A Little Awareness Can Make a Big Difference

Diabetes management involves daily decisions, but emergencies don't always follow a predictable schedule. Knowing the warning signs and understanding when home care is no longer enough can help families recognize when to seek medical attention.

This Diabetes Awareness Month, take time to learn the symptoms, understand the person's emergency plan, and talk with family members about what to do if blood sugar drops too low or rises too high.

If you or someone close to you is experiencing a possible diabetic emergency, don't wait for symptoms to become more severe. Call 911 for life-threatening symptoms.

For more questions about our emergency services or locations, call (214) 494-8222.