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Emergency Symptoms for People Who Use Insulin

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Emergency Symptoms for People with Diabetes

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 may also be related to insulin resistance, a condition that arises when the body's cells become less sensitive to the effects of insulin. 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 with diabetes 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 and has the following symptoms, seek emergency medical assistance.

Hypoglycemia

Low blood sugar, known as hypoglycemia, can develop quickly if someone with diabetes uses too much insulin or other medications used to treat diabetes, 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:

  • Weakness

  • Shaking

  • Sweating

  • Headache

  • Nervousness or moodiness

  • Hunger

  • Pale skin

  • Clumsy or jerky movements

  • Confusion or difficulty paying attention

  • Tingling sensation around mouth

  • Seizure

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 because it takes the body more time to digest these foods. 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

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

  • Frequent urination

  • High blood sugar levels

  • Fatigue

  • Dry or flushed skin

  • Nausea, vomiting, or abdominal pain for more than two hours

  • Difficulty breathing

  • Fruity odor on breath

  • Confusion

If these symptoms occur, call 911 or take the person to a hospital emergency room right away.

Prevention

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.