Types of Diabetic Emergencies: What to Do?

Diabetic emergencies include Diabetic ketoacidosis, Hyperosmolar hyperglycemic state, and Hypoglycemia. All these diabetic emergencies are totally preventable and easily treatable.

However, one should have at least some knowledge about these types of diabetic emergencies to identify them at the earliest.

A little delay in the diagnosis can become life-threatening or may incur severe brain damage or kidney failure (in case of hyperglycemic types of diabetic emergencies).

The 3 Types of Diabetic Emergencies:

According to the Centers for Disease Control and Prevention, many people in America have diabetes, with or without a diagnosis.

While in the past, having diabetes was often fatal, nowadays, because of the advancements in medical technology, people with diabetes can now enjoy a normal lifespan.

They can enjoy their lives without worrying about their condition too much. However, it’s still important to take note that diabetes is still one of the most common causes of death in the US, which is something we can’t ignore.

When we discuss death caused by diabetes, we usually need to understand the three different types of diabetic emergencies:

• Low blood sugar (called hypoglycemia),
• Very high blood sugar (known as hyperosmolar hyperglycemic state or HHS, which thickens the blood and affects its flow), and
• Diabetic ketoacidosis (DKA).

Recognizing the symptoms of these situations and knowing what to do if they happen to you or someone you know can help save lives. Now, let’s learn more about each of these conditions.

Hypoglycemia – The most common Diabetic Emergency:

Hypoglycemia is a condition that happens when a person suffering from diabetes has low blood sugar in their body.

A person with below 70 milligrams per deciliter is categorized as hypoglycemia. Without proper immediate medical treatment, the person will have a seizure and endanger their life in minutes.

However, knowing the signs of this condition is usually enough to save the person’s life based on what you already know. Usually, there are several reasons why hypoglycemia can occur, which are the following:

• Taking more insulin than they need
• Excessive alcohol consumption
• Missed or delayed meals
• Too much exercise
• Infections such as pneumonia, urinary tract infections, and GI infections (result in vomiting and diarrhea, and hypoglycemia).

The signs and symptoms of hypoglycemia can be subtle and mistaken as an anxiety attack or severe and mistaken as a seizure.

It is important to know the signs and symptoms of hypoglycemia and always check your blood glucose via a glucometer to confirm hypoglycemia.

Here are the common symptoms of hypoglycemia:

• Hunger
• Feeling shaky, irritable, nervous
• Rapid heartbeat
• Confusion, nausea, dizziness
• Sweating, chills
• Seizures,
• Headaches
• Drowsiness and coma

Once you’ve confirmed that the person is suffering from hypoglycemia, the most optimal things you can do at the moment is call 911 and give them one or two of the following:

• Sugar lump
• Sweet juice
• Candy
• Glucose tablet

If the person is conscious but cannot eat, you could put honey or sweet syrup inside their mouth and continue monitoring their condition.

People who have frequent hypoglycemia and severe hypoglycemia in the hospital are usually managed with intravenous glucose and glucagon injection.

Hyperglycemia and Hyperosmolar Hyperglycemic State (HHS):

• Hyperglycemia:

Mild Hyperglycemia is not usually a serious issue. Although it is associated with long-term complications such as diabetic kidney disease, diabetic eye disease, neuropathy, infections, and atherosclerotic cardiovascular diseases.

In cases of mild hyperglycemia, especially without symptoms, there is no need to call 911. To avoid severe hyperglycemia or HHS, you should inject your insulin on time, avoid sweets and beverages, and drink plenty of water.

Patients who have persistent hyperglycemia in the ranges of 300 to 500 mg/dl and who are symptomatic do not have the hyperglycemic type of diabetic emergency.

However, it is best to control your blood glucose with these simple hacks to prevent yourself from developing long-term complications:

• First is exercising more. It is recommended to exercise for at least 30 minutes daily. You may take vitamin supplements such as Vitamin D and Vitamin B 12 to minimize fatigue and tiredness and even Boost Performance with Nitric Oxide to be more efficient at the gym. However, you should talk to your doctors first before taking any supplements.
• Next is changing the insulin dose or adjusting your diabetes medications, which you should also talk to your doctor about first.
• And lastly, eating less and following the ADA diabetic diet guidelines

This is true, especially with foods that can cause blood sugar spikes. That said, if mild hyperglycemia is neglected, it can become a more life-threatening event, prompting you to call 911 as they need to see a doctor as soon as possible.

That said, how do you know if the case is becoming worse? Usually, if the symptoms worsen over time or the person has difficulty breathing, has a very dry mouth, and their breath is becoming fruitier, then you should call 911.

• Hyperosmolar Hyperglycemic State (HHS):

Hyperosmolar Hyperglycemic State is the exact opposite of hypoglycemia which is that this condition is caused by having a very high level of blood sugar in the body.

This usually happens when there is insufficient insulin to regulate their blood sugar due to overeating sweet food and not injecting enough insulin. That said, here are the warning signs of this condition:

• Increased thirst
• Fatigue
• Blurred vision
• Urinating more frequently
• Headaches

Most patients with HHS are elderly. In addition to skipping insulin and dietary non-compliance, most of these people develop HHS because of underlying infections such as pneumonia and urinary tract infections.

Because the blood in HHS is very thick as a result of high sugars as well as because of dehydration, these patients are at an increased risk of strokes, angina, myocardial infarction, pulmonary embolism, deep vein thrombosis, kidney failure, and death.

If your blood sugars cross 500 mg/dl and you develop a severe thirst, reduced urine output, dizziness, blurring, and weakness, you should immediately call 911.

Here is a table comparing the two different types of diabetic emergencies:

Diabetic Ketoacidosis

Diabetic Ketoacidosis usually happens when the body doesn’t have enough insulin to let the glucose enter the cells properly.

The cells would then not have enough glucose to use for energy, which can lead the body to use fats as an energy source.

When this happens, the body produces ketones. Low levels of ketones are fine, but higher levels can be toxic because they will raise the acidity in your blood. There are several reasons why this condition happens:

• Low insulin levels (relative or absolute insulin deficiency)
• Not following diabetic dietary recommendations (eating carbohydrate-rich foods and foods high in calories)
• Stress (Physical in the form of infections or surgery or psychological)
• Medications like Jardiance, Farxiga, and Invokana which cause euglycemic ketoacidosis

So what are the warning signs of this condition? Usually, the symptoms are very similar to hyperglycemia, which is bad, so you should call 911 immediately if you have a clue that DKA is happening. Here are the symptoms:

• Fatigue
• Dry skin and oral cavity
• Frequent urination
• Feeling thirsty
• Fruit breath smell
• nausea, vomiting, dizziness
• Abdominal pain
• Rapid and deep breathing

That said, here is what you should do if you have a feeling that the person is having DKA, which you can usually figure out using a blood glucose test recommended to be brought by the diabetic person anywhere they go.

You should call an ambulance immediately once you see that the blood sugar level is 250 m/dl or above in the presence of the above symptoms or your Ketometer shows positive ketones in your blood or urine.

Here is a table comparing DKA with HHS:

Final Words

The three different types of diabetic emergencies are easily preventable and treatable if identified early in the course of the disease.

In milder cases, it’s usually nothing to worry about, but once you see that the symptoms are worsening, that should prompt you to call the ambulance immediately.

Each one of these conditions worsening can become life-threatening, which is why we should always be on our toes when one of our loved ones is having one of these conditions.