Diabetes Emergencies: How You Can Help

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.

Hypoglycemia

This is what doctors call low blood sugar. It happens when someone has too much insulin compared with glucose in their blood. Sometimes hypoglycemia is called "insulin shock."

It's more common for people with type 1 diabetes, but people with type 2 diabetes who take insulin and other medicines to control blood sugar can get it, too. It can happen when they:

  • Skip a meal
  • Exercise more than usual
  • Drink alcohol
  • Take too much insulin

Most people with diabetes can tell when their blood sugar is low because of early warning signs like shakiness and hunger. 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.

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.

What it looks like: Signs of severe hypoglycemia include:

What you can do: Ask them to check their blood sugar if you think they're going "low." Help them get what they need to follow the 15/15 rule: Eat 15 grams of fast-acting carbs (3-4 glucose tablets or gels, 4 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.

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Diabetic Ketoacidosis

Diabetic ketoacidosis, or DKA, is a life-threatening emergency caused when you don't have enough insulin and your liver has to break down fat into ketones for energy, but too fast for the body to handle. A buildup of ketones can change your blood chemistry and poison you. You could fall into a coma.

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. The person may have:

  • Not injected enough insulin, or needs more than usual
  • Not eaten enough food
  • Had an insulin reaction (low blood sugar) while they were sleeping

The most common DKA trigger is being sick or having an infection. Some medicines or a big stress, like having a heart attack, can cause it, too. DKA can happen fast, usually in less than 24 hours.

What it looks like: The early symptoms are:

More serious symptoms are:

  • Tired all the time
  • Dry or flushed skin
  • Breath that smells fruity
  • Nausea, vomiting, or belly pain
  • Trouble breathing
  • Feeling woozy, confused, or passing out

If someone has early signs, 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.

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Hyperosmolar Hyperglycemic Syndrome (HHS)

High blood sugar (hyperglycemia) can cause very serious problems, too. HHS isn't as common as DKA, but it's more dangerous. It's a complication of type 2 diabetes with very high blood sugar -- over 600 mg/dL -- but no or very few ketones.

HHS (which used to be known as HHNS, hyperosmolar hyperglycemic nonketotic syndrome) happens most often in older people with uncontrolled diabetes who are sick or have an infection. It might also affect obese pregnant women with uncontrolled diabetes.

Their blood sugar rises over days or even weeks, and their body tries to get rid of the excess glucose by peeing more. When they don't drink enough fluid to keep up, they get extremely dehydrated and can get HHS. It can cause seizures, coma, and even death.

What it looks like:

  • 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

What you can do: Call their doctor, then get them to the emergency room or urgent care.

Preeclampsia

Having diabetes of any type while you're pregnant -- type 1, type 2, or gestational -- raises the odds of preeclampsia, a serious condition related to high blood pressure that can put the mom's and baby's health in danger. The baby may have to be delivered, even if they haven’t fully matured yet. The exact cause of preeclampsia isn't known.

Delivery doesn't cure preeclampsia. Moms will need medical care if they still have symptoms after their baby is born. Also, any woman can have preeclampsia after delivery, even if she didn't have it while she was pregnant.

What it looks like: Many women who have preeclampsia often don't feel sick, or they think that what they're feeling is a normal part of being pregnant. Some of the more serious symptoms are:

  • Blurred vision, seeing spots or flashing lights, or sensitivity to light
  • Headache that doesn't go away
  • Severe swelling of the face, hands, and feet -- when you press your finger into the puffiness, a dent remains for a few seconds
  • Pain under the right ribs or in the right shoulder
  • Low back pain with any other symptom
  • Gaining more than 2 pounds in a week
  • Vomiting later in the pregnancy
  • Anxiety and shortness of breath they haven't had before

What you can do: Call their doctor. You may need to take them for medical care immediately.

WebMD Medical Reference Reviewed by Michael Dansinger, MD on November 19, 2018

Sources

SOURCES:

American Diabetes Association: "Hypoglycemia (Low Blood Glucose)," "DKA (Ketoacidosis) & Ketones," "Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)."

Mayo Clinic: "Diabetic hypoglycemia," "Diabetic hyperosmolar syndrome," "Gestational diabetes."

Goodman Diabetes Service, Albany Medical Center: "Severe Hypoglycemia & Hypoglycemia Unawareness."

St John Ambulance: "Diabetic emergency."

Joslin Diabetes Center: "How To Treat A Low Blood Glucose."

Adeyinka, A. Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome), StatPearls Publishing, 2018.

Family Doctor: "Diabetic Ketoacidosis."

The Johns Hopkins Patient Guide to Diabetes: "Hyperosmolar Hyperglycemic State (HHS)."

American Journal of Perinatology: "Hyperosmolar hyperglycemic state of pregnancy with intrauterine fetal demise and preeclampsia."

Current Diabetes Reports: "Preeclampsia and Diabetes."

Preeclampsia Foundation: "Postpartum Preeclampsia: Moms are Still at Risk After Delivery," "Signs & Symptoms."

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