Diabetic Emergencies:
Recognising and Responding to Hypoglycaemia and Hyperglycaemia

Diabetes is a condition that affects the body’s ability to regulate blood sugar (glucose) levels. While many people with diabetes manage their condition with medication, diet, and lifestyle, diabetic emergencies can still occur. These emergencies happen when blood sugar levels become dangerously low (hypoglycaemia) or too high (hyperglycaemia). Knowing how to recognise and respond to these emergencies is crucial to prevent serious complications.

What is Hypoglycaemia (Low Blood Sugar)?

Hypoglycaemia occurs when blood sugar levels drop below normal. This is often due to taking too much insulin or other diabetes medication, missing a meal, excessive physical activity, or drinking alcohol without eating enough. Low blood sugar can happen quickly and requires immediate action to prevent the person from losing consciousness or experiencing more severe complications.

Signs and Symptoms of Hypoglycaemia

Early recognition of hypoglycaemia is important, as it can worsen rapidly. Common signs include:

• Shakiness or Trembling: The person may feel unsteady or jittery.
• Sweating: Excessive sweating, even in cool temperatures.
• Hunger: A sudden, intense feeling of hunger.
• Pale Skin: The person’s skin may appear pale or clammy.
• Fatigue or Weakness: The person may feel weak, tired, or drowsy.
• Dizziness or Light-headedness: They may feel faint or unsteady.
• Confusion or Difficulty Concentrating: The person may have trouble thinking clearly or become disoriented.
• Irritability or Mood Changes: Hypoglycaemia can cause sudden mood swings, anxiety, or irritability.
• Blurred Vision: Vision may become blurry or distorted.
• Slurred Speech: The person may have difficulty speaking or sound as though they are intoxicated.

If untreated, hypoglycaemia can lead to more severe symptoms, including:

• Seizures.
• Unconsciousness.
• Coma.

First Aid for Hypoglycaemia

1. Provide Fast-Acting Sugar:

• If the person is conscious and able to swallow, give them fast-acting sugar (20grams). This can be:
  • 3-4 glucose tablets.
  • A sugary drink, such as fruit juice or a non-diet soft drink.
  • 5-6 jelly babies or other sugary sweets.
  • 1-2 teaspoons of honey or sugar.
• These quickly raise blood sugar levels and help relieve symptoms.

2. Monitor for Improvement:

• After consuming sugar, the person should begin to feel better within 10-15 minutes. If they do not improve or their symptoms worsen, Dial 999 seek medical help immediately.
• Once their symptoms improve, follow up with a snack containing longer-lasting carbohydrates, such as a sandwich, a piece of fruit, or a cereal bar, to maintain their blood sugar levels.

3. Call 999 if Necessary:

• If the person is unconscious or unable to swallow, do not give them anything by mouth. Instead, call 999 for emergency medical help.
• Place the unconscious person in the recovery position and monitor their breathing and condition until help arrives.

What is Hyperglycaemia (High Blood Sugar)?

Hyperglycaemia occurs when blood sugar levels become too high. This can happen if the person misses a dose of insulin or other diabetes medication, eats too much sugar, experiences stress, or has an infection. High blood sugar levels can develop over hours or days and can lead to a serious condition called diabetic ketoacidosis (DKA), particularly in people with type 1 diabetes.

Signs and Symptoms of Hyperglycaemia

• Excessive Thirst: The person may feel constantly thirsty, even after drinking fluids.
• Frequent Urination: They may need to urinate more frequently than usual, especially at night.
• Dry Mouth: A persistent feeling of dryness in the mouth.
• Fatigue: The person may feel unusually tired or lethargic.
• Blurred Vision: High blood sugar levels can cause blurred or distorted vision.
• Nausea or Vomiting: The person may feel sick or vomit.
• Fruity-Smelling Breath: This is a sign of diabetic ketoacidosis, where the body starts to break down fats for energy, producing ketones that cause a fruity smell on the breath.
• Abdominal Pain: Severe hyperglycaemia can cause stomach pain or discomfort.
• Confusion: The person may become confused or disoriented.

First Aid for Hyperglycaemia

1. Encourage the Person to Take Their Medication:

• If the person is aware of their condition and recognises the symptoms of hyperglycaemia, they may need to take their insulin or other diabetes medication. Encourage them to do so according to their prescribed treatment plan.

2. Encourage Hydration:

• Drinking water can help flush excess sugar out of the body through urination and prevent dehydration. Encourage the person to drink water if they are able to do so.

3. Monitor for DKA:

• If the person’s symptoms worsen or they develop signs of diabetic ketoacidosis (DKA) (such as fruity-smelling breath, nausea, vomiting, or abdominal pain), call 999 immediately. DKA is a medical emergency that requires urgent treatment in hospital.

4. Seek Medical Help:

• If the person’s blood sugar levels remain high despite taking medication, or if they show signs of DKA, they need urgent medical attention. Call 999 for advice and support.

When to Seek Medical Help

• For Hypoglycaemia: If the person loses consciousness, has a seizure, or does not improve after consuming sugar, call 999 for emergency help.
• For Hyperglycaemia: If the person develops signs of DKA, including fruity-smelling breath, nausea, vomiting, or confusion, call 999 immediately.

Prevention Tips for Diabetic Emergencies

• Monitor Blood Sugar Levels: Regularly check blood sugar levels as directed by a healthcare professional to prevent extremes.
• Follow a Balanced Diet: Maintaining a healthy diet that balances carbohydrates, proteins, and fats can help regulate blood sugar levels.
• Take Medications as Prescribed: Ensure that diabetes medications, including insulin, are taken according to the prescribed treatment plan.
• Stay Hydrated: Drink plenty of water to avoid dehydration, especially during periods of illness or physical activity.
• Carry a Medical ID: People with diabetes should wear a medical identification bracelet or carry a card that indicates their condition in case of an emergency.

Key Points to Remember

• For hypoglycaemia, act quickly by giving fast-acting sugar and monitor the person’s condition. Call 999 if they are unconscious or do not improve.
• For hyperglycaemia, encourage the person to take their medication and stay hydrated. Call 999 if they show signs of diabetic ketoacidosis.
• Monitor the person’s breathing and consciousness, and be prepared to administer CPR if necessary.