Diabetes requires careful daily management, but rapid changes in health status can constitute a medical emergency requiring immediate attention. These acute, life-threatening events, termed diabetic emergencies, involve severe shifts in the body’s metabolic balance. If not addressed swiftly, these shifts can lead to seizures, coma, or death. Recognizing the specific symptoms and blood sugar thresholds that signal a crisis is paramount for anyone living with or caring for a person with diabetes.
When Low Blood Sugar Becomes Critical
The body’s primary fuel source is glucose, and a dangerous drop in blood sugar, known as severe hypoglycemia, quickly deprives the brain of energy. Hypoglycemia is defined as a blood glucose reading below 70 mg/dL, but a severe event is considered below 54 mg/dL where mental or physical function is impaired. The most alarming indicators of a severe drop are neurological symptoms, which arise as the brain struggles without glucose.
Symptoms include profound confusion, disorientation, slurred speech, uncoordinated movements, and an inability to perform simple tasks. If the patient progresses to having a seizure or losing consciousness, the situation is life-threatening and requires immediate emergency medical services. Emergency help must also be called if the person is conscious but unable to safely swallow fast-acting carbohydrates, such as glucose tablets or juice. If a glucagon emergency kit has been administered without a rapid recovery of consciousness, professional medical assistance is needed.
Identifying Hyperglycemic Crises
Extremely high blood sugar levels can trigger two major life-threatening conditions: Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). DKA occurs most commonly in people with Type 1 diabetes and is characterized by a severe lack of insulin, causing the body to break down fat for energy and release acidic compounds called ketones. This process leads to metabolic acidosis, often presenting with blood glucose readings above 250 mg/dL and high levels of ketones in the blood or urine.
Physical symptoms of DKA include persistent nausea and vomiting, abdominal pain, and extreme fatigue. A distinctive sign is Kussmaul breathing, a pattern of deep, rapid, and labored breaths used to expel excess carbon dioxide and compensate for acid buildup. The breath may also have a sweet or fruity odor due to the presence of acetone.
HHS is a crisis state more commonly seen in older adults with Type 2 diabetes, involving severe hyperglycemia and dehydration without significant ketosis. Blood glucose levels in HHS are much higher than in DKA, often exceeding 600 mg/dL, resulting in dangerously high blood osmolality. The lack of insulin is sufficient to prevent massive ketone production but not enough to control the rise in glucose.
Because HHS develops more slowly, often over days or weeks, symptoms of dehydration and neurological changes are often more pronounced. Patients may show profound lethargy, confusion, hallucinations, or focal neurological deficits that can be mistaken for a stroke. Both DKA and HHS disrupt the body’s fluid and electrolyte balance, demanding hospitalization for intravenous fluids, insulin therapy, and close monitoring.
Urgent Situations Beyond Blood Glucose Levels
An immediate emergency room visit is warranted for diabetic patients even when blood glucose levels are stable, provided there is a concurrent severe health issue. Diabetes significantly compromises the body’s ability to fight infection and maintain fluid balance during illness. Any severe, uncontrolled infection can rapidly trigger a metabolic crisis due to stress hormones raising blood sugar and increasing fluid loss.
A diabetic foot infection presenting with cellulitis, deep abscess, or signs of systemic infection like fever and chills requires immediate hospital attention to prevent limb loss or sepsis. Impaired healing mechanisms mean that even a minor wound can quickly progress to a life-threatening condition. If a patient experiences persistent vomiting or severe diarrhea for more than a few hours, the inability to keep fluids and medications down leads to rapid dehydration and electrolyte imbalance. This high risk for rapid metabolic deterioration requires emergency intravenous support.
Preparing for the Emergency Room Visit
Preparing a concise set of information before heading to the emergency room can significantly speed up diagnosis and treatment. The most important priority is identifying the patient as having diabetes to emergency medical personnel. Having a copy of the patient’s health insurance card and photo identification will streamline the admission process.
Essential Kit Contents
A readily accessible kit should contain the following information:
- A complete list of all current medications, including insulin type, dosage schedule, and time of the last dose.
- The patient’s most recent blood glucose and ketone readings, if available.
- Contact information for their endocrinologist or primary care doctor.
- A copy of the patient’s health insurance card and photo identification.
For patients using an insulin pump or continuous glucose monitor (CGM), also include the device’s make, model, serial number, and current pump settings like basal rates and insulin-to-carbohydrate ratios.