Category: Health & Safety

Recognizing & Responding to a Diabetic Emergency

A diabetic emergency can happen when a person’s blood sugar becomes dangerously low or dangerously high. Both situations can become serious, but they require different responses.

The person may become confused, weak, unsteady, unusually sleepy, or unable to explain what is wrong. Their behavior may even make them appear intoxicated. Recognizing that the problem could be related to diabetes can help you respond quickly and avoid actions that might make the situation worse.

If someone is unconscious, having a seizure, unable to swallow safely, having serious difficulty breathing, or becoming rapidly less responsive, call 911 immediately.

Understanding Blood Sugar Emergencies

The body uses glucose, commonly called blood sugar, for energy. Insulin helps glucose move from the bloodstream into the body’s cells.

A diabetic emergency may occur when there is:

Too little glucose in the bloodstream, called hypoglycemia or low blood sugar
Too much glucose in the bloodstream, called hyperglycemia or high blood sugar
A dangerous buildup of acids called ketones, which can lead to diabetic ketoacidosis
Severe dehydration and extremely high blood sugar, which can lead to hyperosmolar hyperglycemic state

Low blood sugar often develops quickly. High blood sugar emergencies usually develop more gradually, although they can sometimes worsen rapidly.

You do not need to diagnose the exact problem before calling for help. Focus on the person’s symptoms, level of responsiveness, ability to swallow, and whether they are getting better or worse.

Helpful Resources: Browse Temperature & Basic Health Monitoring for products, equipment, services, or supplies related to this section.

Signs of Low Blood Sugar

Blood sugar below 70 mg/dL is generally considered low. A person’s healthcare provider may give them a different level at which they should take action.

Common signs of low blood sugar include:

Shaking or trembling
Sweating or cold, clammy skin
Sudden hunger
Dizziness or lightheadedness
Weakness
Headache
Nervousness, anxiety, or irritability
Fast heartbeat
Blurred vision
Difficulty concentrating
Confusion
Unusual behavior
Trouble walking or speaking clearly
Sleepiness

Severely low blood sugar may cause:

Inability to treat oneself
Inability to swallow safely
Loss of coordination
Seizure
Loss of consciousness

Some people develop hypoglycemia unawareness, which means they may not notice the usual early warning signs. This makes readings from a glucose meter or continuous glucose monitor especially important.

According to the CDC’s guidance on low blood sugar, severe low blood sugar can cause confusion, unusual behavior, seizures, or fainting and may require another person’s help.

Common Causes of Low Blood Sugar

Low blood sugar can occur when someone:

Takes too much insulin or certain diabetes medications
Skips or delays a meal
Eats fewer carbohydrates than expected
Exercises more than usual
Drinks alcohol, especially without eating
Becomes sick and cannot eat normally
Changes their routine, medication, or activity level
Has kidney, liver, or other medical problems that affect medication use

Low blood sugar can also happen several hours after physical activity or during sleep.

What to Do for Mild or Moderate Low Blood Sugar

If the person is awake, responsive, and able to swallow safely:

1. Have the person check their blood sugar

Help them use their glucose meter or continuous glucose monitor if they normally use one and want assistance.

Do not delay treatment when the symptoms strongly suggest low blood sugar and checking is not immediately possible. When a conscious person with diabetes has symptoms of low blood sugar, giving a measured amount of fast-acting carbohydrate is generally safer than waiting for the symptoms to worsen.

2. Give 15 grams of fast-acting carbohydrate

Appropriate choices may include:

4 ounces, or approximately one-half cup, of fruit juice
4 ounces of regular soda, not diet soda
3 or 4 glucose tablets, depending on the product instructions
One dose of glucose gel, according to its label
1 tablespoon of sugar, honey, or syrup
The labeled amount of hard candy needed to provide approximately 15 grams of carbohydrate

Use the amount shown on the product label whenever possible.

Chocolate, cookies, ice cream, and other high-fat foods are not the best first treatment. Fat can slow the absorption of sugar.

3. Wait 15 minutes

Allow time for the carbohydrate to work. Keep the person seated in a safe place and watch for worsening symptoms.

4. Check again

Recheck the person’s blood sugar after 15 minutes if testing equipment is available.

If the reading is still below 70 mg/dL, or symptoms have not improved, give another 15 grams of fast-acting carbohydrate and wait another 15 minutes.

Continue until the blood sugar returns to the person’s target range and symptoms improve. This is commonly called the 15-15 rule and is recommended in the CDC’s treatment guidance for hypoglycemia.

5. Follow with food that lasts longer

Once the person is feeling better and can eat safely, they may need a meal or a snack containing carbohydrates and protein, especially if their next regular meal is more than an hour away.

Examples include:

Crackers and cheese
Half a sandwich
Yogurt and fruit
Peanut butter and crackers

Follow the person’s established diabetes care plan when one is available.

When Low Blood Sugar Is a 911 Emergency

Call 911 immediately if the person:

Is unconscious or cannot be awakened
Is having a seizure
Cannot swallow safely
Is severely confused or combative
Is unable to treat themselves
Does not improve after repeated treatment
Has been injured during the episode
Has serious trouble breathing
Has symptoms of a heart attack or stroke
Does not have a known history of diabetes and the cause is uncertain

Do not try to force food, liquid, glucose gel, or medication into the mouth of someone who is unconscious, having a seizure, or unable to swallow. They could choke or inhale it into their lungs.

Using Glucagon for Severe Low Blood Sugar

Glucagon is an emergency medication that raises blood sugar. It may be available as an injection, an auto-injector, or a nasal product.

Glucagon may be needed when a person with suspected severe low blood sugar:

Is unconscious
Is having a seizure
Cannot swallow safely
Is too confused to eat or drink
Cannot treat themselves
Is not responding adequately to oral carbohydrate

If glucagon is available and you have been trained to use it:

Call 911 or have someone else call.
Follow the instructions packaged with that specific glucagon product.
Place an unconscious but breathing person on their side after administering it, unless an injury makes movement unsafe. Glucagon can cause nausea or vomiting.
Stay with the person and monitor their breathing.
Begin CPR if they stop breathing normally and you know how to provide it. Follow the dispatcher’s instructions.
When they are fully awake and can swallow safely, give a fast-acting source of sugar followed by a carbohydrate-and-protein snack, unless emergency personnel tell you otherwise.

Emergency medical evaluation is still needed after glucagon is used. The American Diabetes Association recommends glucagon when a person cannot safely swallow carbohydrates, cannot treat themselves, or becomes unconscious.

What to Do During a Seizure

If low blood sugar causes a seizure:

Call 911.
Move dangerous objects away from the person.
Protect their head with something soft if possible.
Do not hold them down.
Do not place anything in their mouth.
Do not give food, drink, or glucose gel by mouth.
Time the seizure.
Use glucagon if it is available, indicated by the person’s emergency plan, and you know how to administer it.
Once the movements stop, check whether the person is breathing normally.
Follow the emergency dispatcher’s instructions.

Stay with the person until emergency help arrives.

Signs of High Blood Sugar

High blood sugar often develops more gradually than low blood sugar.

Possible signs include:

Increased thirst
Frequent urination
Dry mouth
Fatigue or weakness
Blurred vision
Headache
Difficulty concentrating
Slow-healing cuts
Nausea
Unexplained weight loss

High blood sugar can result from illness, infection, stress, missed medication, insufficient insulin, equipment problems with an insulin pump, or changes in eating and activity.

A single high reading does not always mean the person is having an emergency. Follow the person’s diabetes care plan and watch for worsening symptoms.

Do not give someone an extra dose of insulin unless they can safely administer it themselves according to their prescribed correction plan or a qualified healthcare professional gives specific instructions. Too much insulin can cause life-threatening low blood sugar.

Recognizing Diabetic Ketoacidosis

Diabetic ketoacidosis, or DKA, develops when the body does not have enough insulin and begins breaking down fat for energy. This produces acids called ketones.

DKA occurs most often in people with type 1 diabetes, but it can also occur in people with type 2 diabetes. It may be the first noticeable sign that someone has diabetes.

Warning signs may include:

Very high blood sugar
High ketone levels
Extreme thirst
Frequent urination
Nausea or vomiting
Abdominal pain
Severe fatigue or weakness
Deep, rapid, or labored breathing
Fruity-smelling breath
Dry skin or signs of dehydration
Confusion
Fainting or loss of consciousness

DKA is a medical emergency and requires hospital treatment. The National Institute of Diabetes and Digestive and Kidney Diseases identifies trouble breathing, fruity-smelling breath, extreme fatigue, and fainting as possible DKA symptoms requiring immediate treatment.

Recognizing Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state, sometimes called HHS, is another life-threatening high blood sugar emergency. It is more common in people with type 2 diabetes, particularly older adults, and may develop over several days.

Possible warning signs include:

Extremely high blood sugar
Extreme thirst
Frequent urination early in the illness
Very dry mouth and skin
Severe dehydration
Weakness
Fever
Vision problems
Confusion or unusual behavior
Drowsiness
Seizures
Loss of consciousness

Call 911 when a person with very high blood sugar becomes confused, severely weak, difficult to awaken, or otherwise seriously ill.

What to Do for Suspected High Blood Sugar

If the person is awake and able to manage their own care:

Help them check their blood sugar.
Encourage them to follow their written diabetes sick-day or high-blood-sugar plan.
Help them check ketones if their care plan calls for it and supplies are available.
Encourage water or another sugar-free fluid if they are alert, able to swallow, and have not been told to restrict fluids.
Help them contact their healthcare provider for instructions.
Watch for vomiting, breathing changes, confusion, worsening weakness, or inability to drink.

The CDC advises people who are sick and have blood sugar of 240 mg/dL or higher to check for ketones and contact their doctor if ketones are high. Individual instructions may differ, so the person’s established care plan should take priority. CDC blood sugar management guidance

When High Blood Sugar Requires Emergency Help

Call 911 or seek immediate emergency care if the person has:

Trouble breathing or deep, rapid breathing
Fruity-smelling breath with other symptoms
Repeated vomiting
Severe abdominal pain
Confusion or unusual behavior
A seizure
Fainting or loss of consciousness
Severe dehydration
Inability to keep fluids down
Rapidly worsening symptoms
High blood sugar and moderate or high ketones with serious symptoms
A diabetes emergency plan that directs them to obtain emergency care

Do not drive a severely ill person to the hospital if they may lose consciousness or deteriorate on the way. Call 911 so treatment can begin during transport.

If You Are Not Sure Whether Blood Sugar Is Low or High

Low and high blood sugar can both cause weakness, confusion, sleepiness, and unusual behavior.

If possible, check the person’s blood sugar. If checking is not possible:

Call 911 if the person is seriously confused, unable to swallow, having a seizure, unconscious, or having trouble breathing.
Do not give anything by mouth if they cannot swallow safely.
Do not give insulin based on a guess.
Use glucagon if severe low blood sugar is suspected, the person has it available, and you know how to use that particular product.
Stay with the person and monitor their breathing.
Tell emergency responders about the person’s diabetes, medications, symptoms, and any treatment already given.

Information to Give Emergency Responders

Be ready to explain:

Whether the person has type 1, type 2, gestational, or another form of diabetes
When the symptoms began
The most recent blood sugar reading
Whether a continuous glucose monitor shows a rising or falling trend
Whether ketones were checked
When the person last ate
When they last took insulin or diabetes medication
Whether glucagon, sugar, food, drink, or insulin was given
Whether they have been vomiting or recently ill
Whether they fell, hit their head, or had a seizure
Any other medications, medical conditions, or allergies

Bring the person’s medication list, insulin supplies, glucose meter, and emergency information if doing so will not delay care.

Helping Someone Prepare for an Emergency

A person with diabetes can make emergencies easier to handle by:

Carrying glucose tablets or another fast-acting source of sugar
Wearing a medical identification bracelet or necklace
Keeping glucagon available if prescribed
Teaching trusted people how and when to use glucagon
Keeping a written emergency plan at home, work, or school
Sharing the location of diabetes supplies
Keeping an updated medication list
Knowing personal blood sugar targets
Discussing when to check ketones
Having sick-day instructions from the diabetes care team
Checking expiration dates on glucagon and testing supplies
Keeping emergency contacts easy to find

People who experience repeated low blood sugar, severe lows, or lows without warning should discuss them with their healthcare provider. Medication changes should only be made with professional guidance.

Common Mistakes to Avoid

During a possible diabetic emergency:

Do not assume unusual behavior is caused by alcohol or drugs.
Do not give diet soda for low blood sugar; it does not contain enough sugar.
Do not rely on chocolate as the first treatment for a low.
Do not force anything into the mouth of someone who cannot swallow.
Do not place an object in the mouth of someone having a seizure.
Do not give another person insulin unless directed by their prescribed plan and they can safely manage it.
Do not leave a confused or severely ill person alone.
Do not delay calling 911 while repeatedly trying home remedies.
Do not allow someone who is confused, weak, or recovering from a severe low to drive.

A Simple Emergency Checklist

When someone with diabetes suddenly becomes ill:

Check whether they are awake and breathing normally.
Call 911 for unconsciousness, seizure, inability to swallow, serious breathing trouble, or severe confusion.
Check their blood sugar if this can be done safely.
If it is low and they can swallow, use the 15-15 rule.
If they cannot swallow, do not give anything by mouth.
Use glucagon for severe suspected low blood sugar if it is available and you know how.
Watch for signs of DKA or severe high blood sugar.
Stay with the person until help arrives or they have fully recovered.
Arrange medical follow-up after any severe or unexplained episode.

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Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.