Diabetes is a chronic disease that occurs when the pancreas either produces no insulin (type 1 diabetes) or too little or ineffective insulin (type 2 diabetes). Type 2 diabetes is also called insulin resistance. Insulin is a substance needed to regulate blood sugar levels.
People can manage diabetes with insulin, diet, exercise, and possibly other medications. Under certain circumstances, however, people who take insulin can have symptoms that require immediate action and, in some cases, treatment in a hospital emergency room, according to the American Diabetes Association (ADA).
If you or someone you’re with has diabetes, uses insulin, and has the following symptoms, seek emergency medical assistance.
Low blood sugar, known as hypoglycemia, can develop quickly if someone with diabetes uses too much insulin, exercises too much, or hasn’t eaten enough food. Sometimes it develops without an obvious reason.
According to the ADA, these are symptoms of hypoglycemia:
Nervousness or moodiness
Clumsy or jerky movements
Confusion or difficulty paying attention
Tingling sensation around mouth
These symptoms typically appear when blood sugar levels fall below 70. A very rapid drop in blood sugar—for example, from 230 to 100—can also bring on these symptoms.
If these symptoms occur and a blood sugar test kit is available, do a blood sugar check. If the level is low, give the person several teaspoons of sugar dissolved in a glass of water or a drink containing sugar, such as fruit juice, a cup of skim milk, or regular soda. Foods high in fat, such as a candy bar, are not as effective. If you don’t have a test kit handy, have the person eat sugar anyway.
Symptoms should subside within 15 minutes. Recheck blood sugar in 15 or 20 minutes. If the blood sugar is still low or symptoms are still present, give the person more sugar fluid and test the sugar level again.
If you’re with someone experiencing these symptoms, monitor the person closely. If symptoms become worse—if the person becomes confused, has a seizure, becomes unconscious, or isn’t better in 15 minutes—call 911. Don't try to give an unconscious person food or fluids. If the person has glucagon, a medical substance that is injected like insulin and raises blood sugar, and you are trained in how to inject it, give the glucagon, then call 911.
People who have had diabetes for a long time may not have symptoms of hypoglycemia or may have unusual symptoms and not recognize the condition. In these cases, checking blood sugar is the best way to determine if levels are too low.
Ketoacidosis usually only occurs in people with type 1 diabetes. It is a dangerous condition that occurs when blood sugar is too high.
Ketones are acids that are produced when the body doesn't have carbohydrates to use for energy and resorts to using stored fat. Even moderate amounts of ketones in the blood change the blood's delicate acid-base balance. Ketoacidosis occurs when this balance is disrupted. These conditions cause the body to use fat instead of carbohydrates for fuel:
An illness such as a cold, influenza, or other infection
An inadequate amount of insulin, either by injecting too little or by medical conditions that increase the need for insulin
An inadequate amount of food
An undetected episode of hypoglycemia
Ketones appear in the urine when your body doesn't have enough insulin. A simple urine test can determine if ketones are present. The ADA recommends checking for ketones when the blood glucose level is more than 240 mg/dl.
Ketoacidosis usually develops slowly, unless the person is vomiting. Vomiting can cause it to develop in a few hours. Ketoacidosis is usually treated in the hospital. If untreated, ketoacidosis can lead to diabetic coma or even death.
These are symptoms and signs of ketoacidosis:
Thirst or a very dry mouth
High blood sugar levels
Dry or flushed skin
Nausea, vomiting, or abdominal pain for more than two hours
Fruity odor on breath
If these symptoms occur, call 911 or take the person to a hospital emergency room right away.
People with diabetes can learn how to prevent or manage emergency conditions by seeing a doctor or a diabetes educator regularly. Knowledge can help people avoid short-term complications, such as hypoglycemia and hyperglycemia, and delay or slow the onset of long-term complications of diabetes, such as eye, heart, or kidney disease.