Responding promptly to symptoms of a diabetic emergency can be lifesaving.
Causes and types
Both type 1 and type 2 diabetes inhibit the body's ability to manage blood sugar levels. Type 1 diabetes does so by destroying the cells that produce insulin. Type 2 diabetes reduces how responsive the body is to insulin, while not enough insulin is produced to counter the sugar in the body.
Hence, most diabetic emergencies are related to disruptions in a person's blood sugar levels. Occasionally, even too much of a drug being used to treat diabetes can trigger a diabetic emergency.
The most common diabetic emergencies include the following:
Hypoglycemia is when blood sugar levels are abnormally low. When blood sugar dips very low, it becomes a medical emergency.
Hypoglycemia occurs when blood sugar levels get too low, which can happen after a delayed or missed meal.
Hypoglycemia normally only occurs in people with diabetes who take medication that lowers blood sugar.
Blood sugar levels may drop dangerously low when a person is:
- consuming too much alcohol
- exercising, especially without adjusting food intake or insulin dosage
- missing or delaying meals
- overdosing on diabetic medication
Diabetic ketoacidosis occurs when the body does not have enough insulin to break down glucose properly, and hormones that normally work opposite insulin are high.
Over time, the body releases hormones that break down fat to provide fuel. This produces acids called ketones. As ketones build up in the body, ketoacidosis can occur.
Common causes of ketoacidosis include:
- uncontrolled or untreated diabetes
- an illness or infection that changes hormone production
- an illness or infection that changes the way the body responds to diabetes treatments
- drug or alcohol abuse
- a heart attack
- some medications, particularly corticosteroids
Hyperglycemic hyperosmolar syndrome
Hyperglycemic hyperosmolar syndrome (HHS) occurs when blood sugar levels become dangerously high.
People with poorly controlled type 2 diabetes are more prone to HHS, but other factors also increase the risk. These include:
- illness or infection
- a heart attack
- using medications that reduce insulin efficacy
- taking medications that promote fluid loss
People with diabetes are more prone to infections than people without the disease. Infections may also become more severe, triggering life-threatening complications.
Skin and urinary tract infections are especially common. Minor skin infections can spread to deeper tissue and become life-threatening. Urinary tract infections may spread to the kidneys or elsewhere in the body.
A recent injury or illness, an open wound, and exposure to people with contagious infections all increase the risk of infection. People with poorly controlled diabetes, or those who have other serious diabetes complications, are also more at risk from infections.
People with diabetes have a higher risk of heart attack and stroke than others.
Diabetes can harm virtually every system in the body, increasing the risk of many other diseases. People with diabetes can experience:
- heart disease, such as a heart attack or stroke
- poor circulation that leads to ulcers in the legs
- loss of limbs
- kidney failure
Poorly controlled diabetes, a history of infections, and having other health conditions all increase the risk of these complications for people with diabetes.
Warning signs and symptoms
Any sudden, unexplained symptom warrants a call to the doctor. People with diabetes should be particularly mindful of the following symptoms:
- significant increases or decreases in urination
- excessive thirst
- sudden weight loss
- being nauseous
- fever accompanied by pain or swelling
- very high or very low blood glucose
It is particularly important to see a doctor if the change in blood sugar level is sudden or occurs in response to a medication change.
The following symptoms indicate a diabetes emergency, and they are examples of when 911 (in the U.S.) should be called or help sought at an emergency room:
- loss of consciousness
- signs of a stroke (drooping face, changes in consciousness, slurred speech)
- swelling or pain in extremities
- blue or numb hands or feet
- intense stomach pain
- fruit-scented breath
- changes in speech or movement
- intense muscle weakness
- unexplained and sudden exhaustion
- signs of a heart attack
Signs of a heart attack include pressure or pain in the center of the chest accompanied by shortness of breath. Chest pain that lasts longer than a minute is always a medical emergency.
What to do in a diabetic emergency
People should not try to treat a diabetic emergency at home. Instead, they should call emergency services as soon as possible.
A diabetic emergency occurs when diabetes symptoms have overwhelmed the body. This means home treatment is unlikely to work and delaying medical care could cause permanent damage or death.
People should not try to treat a diabetic emergency by changing medication or food. Instead, they should call 911 or go to the emergency room immediately.
Some symptoms of diabetic emergencies, such as fruity breath, seem harmless, but they are signs that the body's sugar is very high. It is better to err on the side of caution.
When the blood sugar levels of someone with diabetes are very high or very low, or when their blood pressure is very high or very low, this is a clear signal that symptoms are serious.
When a loved one or a friend has diabetes and displays unusual behavior, seems confused, or complains of any of the symptoms of a diabetes emergency, people should not try to treat it themselves, or adopt a "wait-and-see" approach. Instead, they should encourage the person with the symptoms to seek emergency care immediately.
Not all diabetic emergencies can be prevented. Diabetes is a chronic illness, and as it progresses, it can become harder to manage.
However, a number of strategies can reduce the risk of a diabetic emergency. These include:
- Eating healthful, balanced, regular meals. People on insulin therapy, or other diabetes medications that lower blood glucose, should talk to their doctor about the right foods to prevent hypoglycemia. Skipping meals is always dangerous.
- Not drinking too many alcoholic or sugary drinks. People with diabetes are prone to kidney problems, and controlling their sugar and blood pressure can reduce their risk. High-sugar drinks can also raise blood sugar and contribute to obesity.
- Promptly treating signs of infection or illness. Because diabetes damages the organs, it makes the body more prone to a range of infections and ailments. Prompt treatment can prevent minor illnesses from becoming more serious.
- Taking medications exactly as prescribed. Those with diabetes who cannot remember whether or not they took their last dose of drugs should consult a doctor before taking a further dose. This is because an overdose can cause hypoglycemia.
- Exercising regularly. Exercise helps the body better control blood sugar. It can also help with symptoms that often accompany diabetes, such as high blood pressure, obesity, and poor circulation.
Planning for a diabetic emergency
No specific medication or procedure can stop a diabetic emergency once it occurs. Instead, emergency planning should focus on getting prompt help. People with diabetes should:
- tell friends and family they have diabetes
- consider a medical alert bracelet or necklace that gives information to emergency responders if they fall unconscious
- always keep a mobile phone charged and ready to contact emergency responders
- know which doctor to call with questions about diabetes emergencies