Diabetes Emergencies: The Warning Signs

Call 911 if someone with diabetes is unconscious, having a seizure, or too
drowsy to swallow safely. Do not put anything in their mouth.

If they are awake and can swallow, and low blood sugar is possible, give
something sugary now — juice, a sugary drink that is not diet, glucose tablets
if they have them. Low blood sugar is the one diabetes emergency where the
first few minutes at home genuinely change the outcome, and treating it when
you were wrong about it does very little harm.

If they have a glucagon kit prescribed to them and you have been shown how to
use it, use it and call 911.

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Low blood sugar: the one to act on immediately

It arrives fast, often within minutes, and it can look like almost anything:

• Shaking, sweating, a pounding heart
• Sudden hunger
• Confusion, slurred speech, clumsiness — frequently mistaken for being
  drunk
• Irritability or aggression that is out of character. This is the sign
  families miss most, because it does not feel like illness.
• Pale, clammy skin
• Drowsiness, then unconsciousness or a seizure

Give sugar first and ask questions afterwards. If they improve, they still
need food with some substance in it and they still need to know why it happened.

Come in if: it took more than one attempt to bring them round, it has
happened repeatedly, they had a seizure, they live alone, or nobody can explain
why it happened. A low with no explanation is a reason to be seen, because
the cause matters more than the episode.

High blood sugar that has become an emergency

High sugar usually builds over hours or days rather than minutes, and the
danger signs are not the number — they are what comes with it.

Call 911 or come in now for:

• Vomiting that will not stop, especially with high readings
• Deep, fast, sighing breathing, or breath with an unusual sweet or
  nail-polish smell
• Abdominal pain with high sugars
• Drowsiness, confusion, or difficulty waking someone
• Severe thirst with very little urine, dry mouth, sunken eyes — dehydration
  on top of high sugar, which in an Arizona summer can arrive much faster than
  people expect
• Ketones in the moderate or high range if you test for them

These matter more in type 1 than type 2, and they matter in both. In older
people with type 2 the presentation is often confusion and profound dehydration
rather than dramatic breathing, and it can be mistaken for a urinary infection
or simply "not being themselves."

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The sick-day rule people get wrong

Do not stop taking your insulin because you are ill and not eating.

It is a natural conclusion — no food, no insulin — and for someone with type 1
it is how a bad day becomes an emergency. Illness usually pushes blood sugar
up, not down, even when you cannot eat.

What to do instead: keep taking it, test more often than usual, drink fluids
steadily, and call your own clinician or us for advice on adjusting anything.
(480) 237-4922. We would much rather answer that call than see you
twenty-four hours later.

The same applies in Arizona heat, which is its own sick day: fluid losses are
higher, readings move around more, and a stomach bug in July is a different
proposition from the same bug in January.

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Things that are emergencies but do not feel like one

• A foot injury, sore or infection. Reduced sensation means an injury can go
  unnoticed. Redness spreading, any warmth or swelling, a smell, or a sore
  that is not healing — bring it in today rather than next week. We would
  much rather look at a foot that turns out to be fine than see the same foot
  a week later.
• Any infection with a fever. Diabetes raises the stakes, and blood sugar
  control gets harder in both directions.
• Chest pain. Diabetes can blunt pain signals, so a heart attack may
  present as breathlessness, nausea, sweating or unexplained exhaustion with
  little or no chest discomfort. Chest pain: when to go to the ER
• Sudden visual change. Be seen; do not wait for a routine appointment.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• Blood sugar, electrolytes and kidney function run in our own laboratory,
  so the results come back during the visit. For this presentation those numbers
  are the assessment.
• Fluids and treatment for the immediate problem, including the severe end.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours — useful in this presentation specifically,
  because blood sugar and fluid balance are corrected gradually and rechecked
  rather than fixed in one step.
• Imaging on site if a foot or another infection needs it.

If you need admission or hospital-level inpatient care, we stabilise you here
and arrange the transfer. We are an emergency room, not a hospital.

What helps us most: your recent readings if you have them, your insulin or
medication list, what you have taken today and when, whether you have been
vomiting, and whether you test ketones.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Diabetes Complications — https://medlineplus.gov/diabetescomplications.html
• MedlinePlus (National Library of Medicine) — Hypoglycemia — https://medlineplus.gov/hypoglycemia.html
• MedlinePlus (National Library of Medicine) — Hyperglycemia — https://medlineplus.gov/hyperglycemia.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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