How to Handle Diabetic Emergencies – Be Prepared!

There are always things that are coming up in life that can pose a risk to those with diabetes. Sometimes the emergencies include spikes in blood glucose that lead to hyperglycemia. Other situations can lead to very low blood sugar levels, known as hypoglycemia. These emergencies require immediate action to help to balance blood glucose levels and prevent the very serious health complications that can occur. The good news for diabetics is that planning for emergencies in advance can minimize the panic and allow effective and simple options to correct the problem.

Typically emergencies are most common in those people that have been diagnosed with type 1 diabetes and are using insulin therapy. However, those with type 2 diabetes need to also be prepared and know how to handle any rapid or extreme fluctuations in blood glucose levels as well.

Hyperglycemia

High blood glucose, known as hyperglycemia, can occur for several different reasons. Eating large amounts of carbohydrates or fats and low amounts of fiber can lead to an immediate spike in blood glucose. Another common cause of hyperglycemia is forgetting to use your insulin or using too little for the amount of carbohydrates you eat. However, no matter how carefully you select your foods and your insulin therapy dose, there is always a chance that you may find yourself with high blood glucose levels. You may also have eaten a meal and assumed there was going to be a set amount of exercise that would counterbalance your intake, and then the exercise session was cut short or postponed.

If you have hyperglycemia, there are some symptoms that you may experience. They tend to include increased thirst, increased urination, blurry vision, fatigue, unplanned weight loss, and even altered thinking or coma. The confirmation would be a blood test that indicated elevated blood glucose levels.

When you suspect, and tests confirm, that you have hyperglycemia you can increase the amount that you are exercising while keeping your food intake steady. This will work only if your blood glucose is only slightly elevated. You may also want to talk to your doctor about how to test your urine to make sure that ketones are not present. Carrying some of the test strips for ketones in your purse, first aid kit or in your wallet is a simple way to know if it is safe to exercise to bring the blood glucose levels down.

The key is to not allow a condition known as ketoacidosis to develop. This occurs when blood glucose levels are very high and the body is not responding properly to insulin, so the body starts to breakdown fat for energy. The ketones that are released will build up in the body and create a serious health risk. Any signs of vomiting or nausea, trouble breathing, dry mouth or an unusual sweet or fruity taste and smell to the breath indicates that ketoacidosis might be present. Immediate medical treatment is needed to balance the blood glucose levels. If untreated this can result in a coma and, in severe cases, even death.

Always check your blood glucose level before exercising or after a meal if you experience any of the warning signs of hyperglycemia.  Extended times of hyperglycemic are linked to increased risk of heart disease in both women and men, although the largest number of studies in this area have been with males. 1

Hypoglycemia

The opposite of hyperglycemia is hypoglycemia or blood sugar that is too low. This is unfortunately common in diabetics, especially in those taking insulin. You may play one too many games of tennis on a hot afternoon or you may give yourself an insulin injection and then get called away or distracted and fail to eat within a specific amount of time. When this happens the symptoms are often dramatic and extreme. They include feelings of confusion, headaches, dizziness, shaking, difficulty with coordination, tingling sensations in the mouth, emotional changes and seizures.

Most people with diabetes will experience times of hypoglycemia even if they are very careful about blood glucose management and testing. Sometimes medications, health issues or other factors may change the body’s reaction and speed up metabolism, leading to hypoglycemia. In a recent study of 452 type 1 diabetics that drove vehicles it was found that 52% reported at least one hypoglycemic-related driving incident while 5% reported six or more.2  Recognizing the symptoms of hypoglycemia and pulling over before a mishap to restore blood glucose levels is essential, as is regular monitoring for several hours after.

Carrying glucose tablets is a simple way to ensure that you can quickly provide an instant source of glucose. However, if you don’t have glucose tablets on hand, grab any type of simple carbohydrates. Fruit juices, regular sugar sweetened sodas, or table sugar are great sources but so are candies or starchy types of foods such as crackers or bread.  Ideally you should consume approximately 15-20 grams of carbohydrates to give your body the glucose it needs. The good news is that most people recognize the symptoms of hypoglycemia and can provide adequate self-treatment to restore blood glucose levels. In addition research shows that most people will have mild to moderate hyperglycemia, not the life threatening reaction discussed below. 3

In the event that hypoglycemia is not immediately treated you may pass out. This means that the people you are with need to know what to do to save your life. You should talk to friends and family about using a glucagon injection in this situation. They will also need to immediately seek help by calling 911 and getting you to a hospital. If you are not around friends or family, a medical alert bracelet or necklace will alert those who do come to your aid that you are diabetic. This will save the EMS responders significant time spent trying to figure out what the problem is and may lead to quicker treatment for you.

Careful management of diet, exercise and overall health can help to prevent the conditions of hyper and hypoglycemia. Talking to friends and family and providing education to those around you is also important as you may need help and assistance to get immediate care in an emergency situation.

References

1 Barrett-Connor, E., Giardina, E.-G. V., Gitt, A. K., et al. (2004). Women and Heart Disease The Role of Diabetes and Hyperglycemia. Archives of Internal Medicine , 934-942.

2 Cox, D. J., Ford, D., Gonder-Frederick, L., et all. (2009). Driving Mishaps Among Individuals With Type 1 Diabetes. Diabetes Care , 2177-2180.

3 Boyle, P. J., & Zrebiec, J. (2007). Management of Diabetes-related Hypoglycemia. Southern Medical Journal , 183-194.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.