Blood Sugar Emergencies
Diabetes impairs the body’s ability to manufacture or use insulin, a hormone necessary to metabolize sugar or glucose. Most people with diabetes must take either insulin injections or oral medications to lower blood sugar levels. Managing blood sugar levels is a matter of balancing three variables: food, physical activity, and insulin. Insulin and physical activity lower the blood sugar levels; food intake raises them. When blood sugar levels are not maintained properly, people with diabetes are threatened with either of two emergencies:
- Hyperglycemia (high blood sugar), caused by the buildup of glucose in the bloodstream.
- Hypoglycemia (low blood sugar), occurring when blood glucose levels drop too low. Hypoglycemia is also called insulin reaction or insulin shock.
Both situations can be life threatening if left untreated. But because a hypoglycemic emergency can develop quickly and is likely to occur more often, the following information focuses on what causes an insulin reaction and how to handle it.
Why Hypoglycemia Occurs
Controlling blood sugar is no easy task for people with diabetes. Many factors can upset the balance, including illness, stress, medications other than insulin, and alcohol. If the balance is upset—for example, by too much exercise or too little food—the result is an insulin reaction from too much insulin circulating in the bloodstream. Hypoglycemia occurs more commonly with insulin therapy, but it can also happen with some oral medications.
Hypoglycemia Can Happen Easily and Quickly
An insulin reaction can come on at any time and with surprising suddenness. You, your friends and family, and those who work with you should know how to recognize and treat low blood sugar. Be prepared to stop what you’re doing immediately and treat your low blood sugar if you experience any of the symptoms in the following chart.
Warning Signs of Low Blood Sugar
- Headache
- Sweating
- Pale, moist skin
- Cold and clammy
- Extreme/sudden hunger
- Weakness/Dizziness
- Shakiness
- Fatigue/tiredness
- Rapid pulse rate
- Blurred/double vision
- Shallow breathing
- Confusion/inattention
- Loss of coordination
Symptoms that require emergency medical intervention (call 911, administer glucagon if you know how to do so)
- Seizure
- Loss of consciousness
Treatment For Low Blood Sugar—Your Body Needs Sugar, and Fast
Mild Insulin Reaction
Check your blood sugar, if you are able. If your blood sugar is below 70, quickly eat a source of sugar. Common remedies include the following:
- 2-4 glucose tablets or glucose gel (available in drugstores)
- 6 oz. of soda (non-diet)
- 4-6 oz. of fruit juice.
Any fast-acting sugar will do. You will soon learn from experience what works best for you. You should always carry some kind of sugar with you so that you can take care of yourself even if no food is readily available.
If possible, avoid using foods like cake, cookies, pie, ice cream, and chocolate, which have high fat content and therefore relieve hypoglycemia relatively slowly. Because the response time from such foods is slow, people tend to overeat them. Such overeating produces prolonged high blood sugar levels later.
Also, try to avoid overtreatment, which could produce longer high blood sugar levels. Once you’ve taken some sugar, you should rest for 10 to 15 minutes to let your body absorb it. 15 minutes after the treatment retest. If your results are the same , repeat the treatment. If your blood sugar is lower, repeat with higher amount of sugar (double), or call for assistance.
If you have not improved in 30 minutes, call for assistance.
Severe Insulin Reaction
If a person is unable to take food or drink, but is still conscious, instant glucose gel, cake icing in a tube, jam, or syrup can be rubbed between the teeth and the cheek so it can be absorbed without risk of choking. Glucagon may also be given (see below).
When the symptoms have subsided, in order to prevent another reaction, eat something that takes longer to digest. Drink some milk or eat a peanut butter or meat sandwich.
If Unconscious
If unconscious, nothing should be given by mouth. Glucagon, a prescription drug taken by injection, causes blood sugar levels to rise by prompting the liver to release stored glucose. If glucagon is not available, call an ambulance or emergency medical unit. Get the person under supervised care immediately.
Instructions for using glucagon are provided with the product. It is a safe drug, with no danger of overdose. Because occasionally it may cause nausea and vomiting, the person should be lying on his or her side to prevent choking. If the person does not respond fairly quickly, another dose may be administered. When he or she awakens, some form of fast-acting carbohydrates should be eaten right away. The doctor should be notified if a person experiences this type of extreme hypoglycemic reaction.
If there is no response to glucagon, call an ambulance or take the person to the hospital immediately.
Hyperglycemia
The two emergency conditions related to high blood sugar are ketoacidosis and hyperosmolar nonketotic coma. Ketoacidosis is more commonly associated with Type 1 diabetes, and hyperosmolar nonketotic coma occurs more commonly in older people with Type 2 diabetes. Hyperosmolar nonketotic coma can occur when blood sugar levels are high over a prolonged period. Ketoacidosis can occur when the body must break down fats for energy because of a lack of insulin. As a result, poisonous acids called ketones are formed. Both conditions can develop gradually, but are serious, life-threatening emergencies requiring medical treatment.
The symptoms of hyperglycemia are the same as for untreated diabetes. A number of factors can cause high blood sugar, including eating too much, taking too little insulin, skipping your diabetes medication, other medications, or inactivity. Having an infection or being sick or under stress can also cause blood sugar to rise. When you are sick, it’s important to continue taking insulin even if you have trouble eating. Ask your doctor how to handle sick days.
Ketones are excreted in the urine, and special kits are available to test the urine for ketones. Check your urine for ketones if your blood sugar is consistently over 240 and doesn’t come down. Call your doctor whenever your urine tests positive for ketones or if your blood sugar is over 300.
Warning Signs of High Blood Sugar
Slow Onset Warning Signs
- Extreme thirst
- Frequent urination
- Drowsiness, lethargy
- Sugar in urine
- Dry, hot skin
- Lack of appetite
- High levels of ketones in urine
- Fruity, sweet, or wine-like odor on breath
- Heavy, labored breathing
- Stupor, unconsciousness
- Treatment
Call a doctor immediately
Drink fluids WITHOUT SUGAR, if able to swallow, to prevent dehydration
Prevention
Be Aware
Typical causes of hypoglycemia are too little food, eating off schedule, skipping a meal, excessive or unanticipated exercise, and too much insulin. Being aware of such factors and avoiding them can avert an emergency situation.
Self-Monitoring of Blood Glucose
Test your blood sugar often, especially if you have frequent insulin reactions or if your blood sugars are unexpectedly high. If you have high blood sugar in the morning, you may need to test in the middle of the night in order to adjust insulin.
Tell your health care professional if you experience frequent insulin reactions or high blood sugars.
When You Exercise
Insulin works more efficiently when you exercise, which may result in blood sugar that is too low. To prepare for exercise, eat a slowly absorbed snack such as a cheese or meat sandwich. For every 30 minutes of anticipated exercise, eat 15 grams of carbohydrates to cover the increased activity.
Insulin is released more quickly if it is injected into the arm or leg being exercised. If you are going to exercise using your legs primarily (i.e., jogging), don’t inject into your thigh. Choose the arm or abdomen instead.
Be Prepared
- Diabetic emergencies can arise at any time.
- Always carry a source of fast-acting sugar.
- Always carry or wear a form of medical identification, such as Medic Alert, indicating that you have diabetes, what medication you are taking, and the name of your health care provider.
- Always test blood sugar before driving or operating heavy machinery.
- Tell all teachers, family members, caretakers, co-workers, etc. about insulin reactions and their treatment.
Awareness of and prompt attention to the warning signs of low or high blood sugar can avoid a more serious problem.
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