Emergencies

Diabetes Emergencies — Hypos, Highs, and Ketones

2025-08-13 • Updated 2025-09-13

Intro

People with diabetes can experience life-threatening emergencies when blood sugar is too low (hypoglycemia), too high with ketones (diabetic ketoacidosis, DKA), or when vomiting/illness prevents normal control.
Quick recognition and correct action can save lives.

Key Points

• Severe hypo = unconscious, seizure, or unable to swallow → call emergency services.
• DKA risk = high glucose with ketones, vomiting, or illness → urgent action needed.
• Never stop basal insulin, even if not eating.
• Always carry an emergency kit with glucose, glucagon, and ketone testing supplies.

Severe Hypoglycemia (Hypo)

• Signs: confusion, drowsiness, seizure, unconsciousness.
• Do not give food or drink if the person cannot swallow.
• Use glucagon (nasal spray or injection) if available and trained.
• Call emergency services immediately.
• Once awake: give long-acting carbs (bread, biscuits, milk) and contact diabetes team.

High Blood Glucose with Ketones

• Hydrate with sugar-free fluids (small sips every 5–10 minutes).
• Give correction insulin as per plan.
• Recheck blood glucose and ketones after 1–2 hours.
• Pump users: inject correction insulin by pen/syringe and change infusion set.
• Seek urgent care if:
  • Blood ketones ≥ 3.0 mmol/L
  • Ketones continue rising despite correction
  • Vomiting, abdominal pain, drowsiness, or rapid breathing

Vomiting or Unable to Keep Fluids Down

• Very high risk for DKA, even if glucose isn’t extremely high.
• Try frequent small sips of fluid.
• If vomiting persists or fluids not tolerated → go to hospital immediately.
• Do not stop basal insulin — stopping insulin makes DKA worse.

Driving Safety

• If you feel low or your CGM alarms: pull over immediately and treat.
• Do not resume driving until blood glucose has recovered and you feel well.

Emergency Kit Checklist

• Glucose tablets/gel; small juice box or soft drink
• Glucagon (check expiry) + quick instructions
• Glucose meter/strips or CGM
• Blood ketone meter and strips
• Spare pen needles/syringes and pump supplies
• Copy of your emergency plan + contact numbers

FAQ

Q: When should I call an ambulance for high blood sugar?
A: If you have vomiting, abdominal pain, drowsiness, rapid breathing, or ketones ≥ 3.0 mmol/L.

Q: Can I stop insulin if I can’t eat?
A: No. Always continue basal (background) insulin. Stopping increases the risk of DKA.

Q: What if I don’t have glucagon available?
A: Call emergency services immediately and put the person in the recovery position until help arrives.

Further Reading

• International Society for Pediatric and Adolescent Diabetes (ISPAD) — Sick Day Guidelines
• American Diabetes Association — Hyperglycemia and Ketones
• NHS — Hypoglycemia

Related Guides

• Emergencies — Guide Hub
• Type 1 Diabetes — Guide Hub
• Blood Glucose Testing — How and When to Check
• Insulin Administration — Pens, Syringes, and Pumps

References

Chiang, J.L., et al. (2018). Type 1 Diabetes Through the Life Span: A Position Statement of the ADA. Diabetes Care, 41(12), 2550–2580.

⚠️ Educational only; not a substitute for professional medical advice. Always call emergency services if diabetes emergencies are suspected.

• #diabetes
• #type 1 diabetes
• #DKA
• #hypoglycemia
• #emergency
• #first aid