Know the Symptoms of a Diabetes Emergency

Find Out Before You're in a Crisis

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When you are diagnosed with diabetes, there's a lot to learn. In addition to the day-to-day basics of diabetes management and treatment, there's learning to recognize the signs and symptoms of two potential diabetes-related conditions: hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). It's important to understand what can cause your blood sugars to spike too high or drop too low and to recognize what your body will feel like if, or when they do.

Understanding these elements can help to prevent a medical emergency.  

Causes of Hyperglycemia

People with diabetes should aim to avoid high blood sugar levels, typically defined as greater than or equal to 180 mg/dL two hours after a meal and greater than 130 mg/dL after an eight-to-ten hour fast. The reason for this is because chronically elevated blood sugars can increase the risk for future diabetes complications, such as eye, heart, kidney and nerve disease.

And while you may have a blood sugar that's out of range from time to time, it is very important to be able to recognize dangerously high blood sugars (typically defined as greater than or equal 250 mg/dL consecutive times). Your blood sugars can rise to dangerous levels when you've skipped your insulin or  haven't taken enough insulin (especially if you have type 1 diabetes) or when your insulin receptors are not working as they should (with type 2).

Overeating carbohydrates and stress can also cause blood sugars to rise. 

Any type of illness, whether it be the common cold, flu, or something else, puts stress on the body, which can affect blood sugar levels. While the body tries to fight the illness, glucose-raising hormones such as glucagon are released.

In addition to raising glucose, these hormones also interfere with the blood-glucose lowering effects of insulin, making diabetes harder to control. How you manage your diabetes when you are sick is important because extremely high blood sugars during illness can result in an emergency. Creating a sick day plan with your health care provider, can help you to plan and prepare for blood sugar related challenges during times of illness. 

Symptoms That Need Attention

If you you don't feel right and think your blood sugar is elevated, test it to confirm. If your blood sugar is elevated and you are aware of the culprit, and it's an isolated event, odds are you can probably correct it on your own—fit in some light exercise, drink extra water, and take your medicine as prescribed. If on the other hand, your blood sugar is very high and you have these symptoms please call your health care professional and/or go to the emergency room:

  • Increased thirst
  • Increased urination
  • Nausea/vomiting
  • Weight loss
  • Deep and/or rapid breathing
  • Abdominal pain
  • Fruity smelling breath
  • Loss of consciousness

Other Hyperglycemia Emergencies

Hyperglycemic Hyperosmolor Nonketotic Syndrome

Hyperglycemic hyperosmolar nonketotic coma (HHNKC) is an extremely serious complication which can happen in people with type 1 or  type 2 diabetes, but most often occurs in those who are non-insulin dependent (type 2 diabetes).

This is defined as a dangerously high blood sugar that is >600 mg/dL. It is typically brought on either by an infection, such as pneumonia or a urinary tract infection, or poor management of your blood sugar. If left untreated, it can result in coma and even death.

Signs and symptoms include:

  • extreme thirst
  • confusion
  • fever (usually over 101 degrees Fahrenheit)
  • weakness or paralysis on one side of the body

The best way to prevent HHNKC is to take your medications as directed and to keep in contact with your healthcare team when your blood sugar is consistently >300 mg/dL.

Diabetic Ketoacidosis

Hyperglycemia can lead to another very dangerous condition, referred to as diabetic ketoacidosis (DKA), which occurs most commonly in people who have type 1 diabetes and is often the first symptom of type 1 diabetes.

DKA is caused when the body has little or no insulin to use and, as a result, blood sugars rise to dangerous levels and the blood becomes acidic. Cell damage can occur and if it continues to progress, it can cause coma or death. DKA needs immediate medical intervention.

Causes of Hypoglycemia

Hypoglycemia occurs when your blood sugar drops too low (usually below 70 mg/dl), although the tipping point can vary from person to person. It can happen after drinking alcohol, taking too much medicine, not eating enough carbohydrates, or during or after an exercise session. Hypoglycemia may be treated at home if the symptoms are not yet severe and the blood sugar has not fallen too low.

Symptoms That Need Attention

If you begin to feeling shaky, sweaty, dizzy or confused, and you have your meter available, test you blood sugar. If it's less than 70mg/dL treat it with fast acting carbohydrate, such as 3-4 glucose tablets, four ounces of juice, six ounces of soda. Re-test in 15 minutes and repeat treatments if your blood sugar has not gone up. If you don't have your meter, but know that your blood sugar is low, treat it regardless—this will help you to prevent an emergency. If you've treated your blood sugar, and it is not going up, and you continue to have symptoms, please call your health care professional or go to the emergency room. Symptoms to look out for include: 

  • Trembling or weakness
  • Lack of coordination
  • Drowsiness or confusion
  • Headache
  • Dizziness
  • Double vision
  • Convulsions or unconsciousness

When it comes to emergency care, use these symptoms as a guideline, but also listen to your instinct. If you feel that something is wrong, it is never a bad idea to call your healthcare professional or go to an emergency room.

If Your Blood Sugar Has a Tendency to Fall Very Low

If your blood sugar has a tendency to fall very low, very quickly, or has reached a point of clinically significant hypoglycemia, defined by the American Diabetes Association as blood glucose  less than or equal to 54 mg/dL (3.0 mmol/L), glucagon should be prescribed. Glucagon is a hormone that helps the liver release glucose in order to raise blood-sugar levels. It is delivered via a muscular injection and can be self-administered. It usually brings the blood sugar up to an acceptable level within 15 minutes. 

In the extreme event that you are unconscious and unable to administer glucagon yourself, someone else will need to give it to you, whether it be an emergency personnel or someone in your home. If you live with others, they should know how to administer glucagon. Or if you have a child with type 1 diabetes, their teachers should be educated on the use of glucagon. In the instance, you are alone, wearing  some kind of identification that lets emergency personnel know that you have diabetes, like an ID bracelet or wearable emblem can speak for you when you are unable to speak for yourself.

Infections Can Also Lead to a Diabetes Emergency

People with diabetes tend to be more prone to infections and if not treated promptly, infections can trigger more severe complications of diabetes. Infections may alter hormone production or the way the body reacts to diabetes medicines. As a result, blood sugars rise, increasing the risk of ketoacidosis.

In people with poorly controlled diabetes, skin infections or foot injuries, can lead to ulcers which can increase the risk of amputation. 

In the instance you have some sort of infection, it's important to call your health care team right away so that you can be treated quickly. You'll also want to know how to manage your diabetes while your body is under stress. You may need to take more medication during this time. 

How Can You Plan for a Diabetes Emergency? 

The best way to plan for an emergency is to have a sick day/emergency plan. Create one with your medical team, keep a copy in your home and carry a copy along with you when you go out. Within the plan, make sure it includes, a list of all your medicines, doctors, and their contact numbers. You should always wear a form of medical identification, too. 

Lastly, be sure to carry fast acting carbohydrates (glucose tablets, candy juice), extra snacks (whole grain crackers, nuts, low-fat cheese, snack bar, fresh fruit), your blood glucose meter and your medicines with you. 

What's the Best Way to Prevent an Emergency From Happening? 

Practicing good diabetes self management is the best way to prevent emergencies from occurring. This includes: eating a healthy, modified carbohydrate diet, taking your medicines as prescribed, testing your blood sugar regularly, adopting a regular exercise regimen, keeping regular doctors appointments, and avoiding risky behaviors, such as extreme alcohol use. Sometimes, though, you can do everything correctly and yet, you find yourself with blood sugars too high or too low. In this instance, the best way to avoid an emergency is to contact your health care professional right away or to go to the emergency room. It's always better to be overly cautious than to avoid or neglect unusual symptoms. 

A Word From VeryWell

When you have diabetes, it's important to know what symptoms to watch out for to prevent a medical emergency. Most of the time, emergencies are a result of very high or very low blood sugars. Preventing emergencies by practicing good diabetes self management is extremely important, however, sometimes these types of events are out of your control. That's why planning ahead and educating yourself and your family members is so important. 

Sources: 

American Diabetes Association. Standards of Medical Care in Diabetes – 2017. Diabetes Care. 2017 Jan; 40 Suppl 1: S1-S132.

American Diabetes Association. Hyperglycemia (High Blood Sugar). http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html

American Diabetes Association. Hypoglycemia (Low Blood Sugar). http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html