Recognizing Signs of a Diabetic Emergency  

Diabetic emergencies are critical situations in diabetes management that require immediate attention because they can be life-threatening1. 

 

Table of Contents

Signs of Severe Hypoglycemia Arrow icon
Signs of DKA Arrow icon
Signs of HHSArrow icon
Tips to Help Prevent Diabetic
Emergencies Arrow icon

The two most common emergencies, sometimes called “hyperglycemic attacks,” are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Severe hypoglycemia (glucose levels <2.8 mmol/L) is another key concern2.

DKA is most common in type 1 diabetes, while HHS is more often seen in people living with type 2 diabetes3. However, either condition can affect anyone with diabetes. These diabetic emergencies share a key underlying problem: insufficient insulin, which prevents the body from properly processing sugar1. Healthcare providers use blood tests and symptom evaluation to differentiate between DKA and HHS and inform treatment decisions4.

Signs of Severe Hypoglycemia

Symptoms of hypoglycemia include trembling, sweating, nausea, tingling, confusion, weakness, headache, and dizziness2. People with severe hypoglycemia are usually unable to take fast-acting sugar (20 g carbohydrate) on their own to help manage these symptoms and require assistance from someone else2. If someone is unconscious, a glucagon emergency kit should be used, and emergency services should be called5.

Recurrent episodes of hypoglycemia can lead to hypoglycemia unawareness, where symptoms go unnoticed, necessitating frequent blood sugar checks5.

 

Signs of DKA4

Along with the signs of hyperglycemia, DKA symptoms include the feeling of being unable to get enough oxygen, nausea, vomiting, and abdominal pain, collectively referred to as acidosis.

DKA risk factors include heart attack, infection, physical trauma, or inadequate insulin. These factors can quickly trigger DKA, necessitating the need for early recognition and swift management.

 

Signs of HHS

HHS typically includes neurological signs such as vision problems or delirium3. Other symptoms include increased urination and dehydration, as well as weakness and lethargy3. HHS may gradually occur over the course of several days or weeks1.

HHS can follow cardiac surgery or begin to develop with the use of medications such as diuretics, glucocorticoids (a type of steroid), and some psychiatric medications4.

People living with diabetes should regularly monitor their blood sugar during these periods.

 

Tips to Help Prevent Diabetic Emergencies

Preventing diabetic emergencies starts with proactive care. You and your healthcare provider can create a sick-day plan, which includes how to manage your medications should you become ill and guidance on when to call for help4.  

You can take the following steps to help prepare for a diabetic emergency4:

  • If you are sick, monitor your blood glucose every 2 to 4 hours
  • Check ketone (molecules produced from the liver) levels in your urine, which can be done with an at-home test
  • Inform your family and friends about what to do in case of a diabetic emergency

Having a CONTOUR®NEXT GEN meter on hand can provide quick and accurate blood glucose readings, essential for making informed decisions during a diabetic emergency.

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References:

  1. Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. [Updated May 9, 2021]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279052.
  2. Diabetes Canada Clinical Practice Guidelines Expert Committee; Yale JF, Paty B, Senior PA. Hypoglycemia. Can J Diabetes. 2018;42 Suppl 1:S104-S108. doi: 10.1016/j.jcjd.2017.10.010. 
  3. Adeyinka A, Kondamudi NP. Hyperosmolar Hyperglycemic Syndrome. August 12, 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  4. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2013;37 Suppl 1:S72-6. doi: 10.1016/j.jcjd.2013.01.023.
  5. Diabetes Canada. Mild, moderate, or severe hypoglycemia – what’s the difference? Diabetes Canada. Available from https://www.diabetes.ca/managing-my-diabetes/stories/mild,-moderate-or-severe-hypoglycemia---what-s-the-difference-. Published 2024. Accessed December 8, 2024.
  6. Aldhaeefi M, Aldardeer NF, Alkhani N, et al. Updates in the management of hyperglycemic crisis. Front Clin Diabetes Healthc. 2022;2:820728. doi: 10.3389/fcdhc.2021.820728.