Emergencies

Diabetes Emergencies — Hypos, Highs, and Ketones

Quick reference for severe hypos, diabetic ketoacidosis (DKA), and when to call an ambulance.

Updated: 3 min read

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

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.