Diabetes Emergency Guide: Hypoglycemia, Hyperglycemia, and When to Call an Ambulance

Diabetes affects hundreds of millions of people worldwide and is one of the most common chronic conditions managed across all age groups [2]Source: World Health Organization -- Diabetes — World Health Organization. The World Health Organization (WHO) reports that "the number of people living with diabetes rose from 200 million in 1990 to 830 million in 2022," and notes that "hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes" [5]Source: Diabetes — WHO Fact Sheet (14 November 2024) — World Health Organization. The Centers for Disease Control and Prevention (CDC) adds that "more than 40 million Americans have diabetes, and more than 1 in 4 adults with diabetes don't know they have it" [6]Source: Diabetes Basics — CDC — Centers for Disease Control and Prevention (CDC) — many emergencies present in undiagnosed people. While the condition can be controlled with regular monitoring and treatment, sudden drops in blood sugar (hypoglycemia) or dangerous spikes (hyperglycemia) can create life-threatening emergencies within minutes [1]Source: American Diabetes Association — diabetes.org. This guide explains how to recognize the warning signs, what first aid steps to take, and when to call an ambulance.

What Is Hypoglycemia (Low Blood Sugar)?

Hypoglycemia occurs when blood glucose falls below 70 mg/dL [1]Source: American Diabetes Association — diabetes.org. It typically develops after an excessive insulin dose, a skipped meal, or intense physical exercise. It is one of the fastest-developing and most dangerous diabetic emergencies.

Recognizing the Symptoms

• Early signs: Hand tremors, cold sweating, sudden hunger, heart palpitations.
• Progressing signs: Dizziness, difficulty concentrating, irritability, slurred speech.
• Severe signs: Loss of consciousness, seizures.

First Aid for Hypoglycemia

1. If the patient is conscious: Give 15-20 grams of fast-acting sugar immediately [1]Source: American Diabetes Association — diabetes.org -- 4-5 sugar cubes, half a glass of fruit juice, or glucose tablets. Wait 15 minutes and re-check blood sugar. Repeat if levels have not risen.
2. If the patient is unconscious: Never give anything by mouth -- this can cause choking [1]Source: American Diabetes Association — diabetes.org. If a glucagon injection kit is available, administer it according to the instructions. Then call 112 or Nova Ambulans without delay.

Important: After any severe hypoglycemic episode, even if the patient recovers, medical evaluation is strongly recommended. [1]Source: American Diabetes Association — diabetes.org

Hyperglycemia (High Blood Sugar) and Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is a serious, life-threatening emergency in which acidic byproducts called ketones build up in the blood. Blood sugar is usually high (often above 250 mg/dL), but current international diagnostic criteria lowered the hyperglycemia threshold to >=200 mg/dL, and DKA can also develop while glucose is near-normal -- especially in people taking SGLT2-inhibitor medications (euglycemic DKA). For this reason, a low or normal glucose reading alone is not reassuring [7]Source: Hyperglycemic Crises in Adults With Diabetes — ADA/EASD Consensus (Diabetes Care 2024;47(8):1257) — American Diabetes Association / EASD. Mild-to-moderate cases can often be managed in the emergency department or on a ward, while severe cases may require intensive care [1]Source: American Diabetes Association — diabetes.org[7]Source: Hyperglycemic Crises in Adults With Diabetes — ADA/EASD Consensus (Diabetes Care 2024;47(8):1257) — American Diabetes Association / EASD.

Symptoms of DKA

• Extreme thirst and dry mouth
• Frequent urination
• Fruity or acetone-like breath odor
• Nausea, vomiting, and abdominal pain
• Rapid, deep breathing (Kussmaul breathing) [1]Source: American Diabetes Association — diabetes.org
• Confusion, drowsiness, or loss of consciousness

When Should You Call an Ambulance?

If someone with diabetes shows any of the following signs, do not attempt to drive them to the hospital yourself. Call 112 or Nova Ambulans immediately:

1. Unconscious or confused: The patient cannot answer questions coherently or cannot be woken.
2. Seizures: Convulsions triggered by severe hypoglycemia.
3. No response to glucagon: If consciousness does not return within 15 minutes of a glucagon injection. [1]Source: American Diabetes Association — diabetes.org
4. Persistent vomiting: The patient cannot keep fluids down and is becoming dehydrated.
5. Rapid, deep breathing: A sign that the body's acid-base balance is severely disrupted.

Professional ambulance crews can start IV access, administer glucose or insulin as needed, and monitor vital signs throughout transport [3]Source: American Heart Association (AHA) — American Heart Association -- interventions that are simply not possible in a private car.

Staying Prepared: The Diabetic Emergency Kit

Every person living with diabetes -- and their close family members -- should maintain an emergency kit that includes:

• A blood glucose meter with test strips and fresh batteries
• Fast-acting sugar sources (glucose tablets, juice boxes)
• A glucagon emergency injection kit (check expiration dates regularly) [1]Source: American Diabetes Association — diabetes.org
• A written list of current medications, doses, and physician contact information
• Medical ID bracelet or card [1]Source: American Diabetes Association — diabetes.org

Preparation and awareness save lives. Never ignore the symptoms, and never hesitate to call for help.

Nova Ambulans: Your Partner in Diabetic Emergencies

When a diabetic emergency exceeds what can be managed at home, a fully equipped ambulance and trained medical team are essential. Nova Ambulans crews carry blood glucose monitoring equipment, IV supplies, and emergency medications. They begin stabilization at the scene and ensure safe transport to the most appropriate medical facility.

Frequently Asked Questions

How can I tell the difference between hypoglycemia and hyperglycemia?

Hypoglycemia (low blood sugar) causes sweating, trembling, rapid heartbeat, and confusion — it develops quickly. Hyperglycemia (high blood sugar) develops gradually with symptoms like excessive thirst, frequent urination, blurred vision, and fruity breath odor.

When should I call an ambulance for a diabetic emergency?

Call immediately if the person loses consciousness, has a seizure, cannot swallow safely, has blood sugar below 54 mg/dL that doesn't respond to glucose, or shows signs of diabetic ketoacidosis (vomiting, abdominal pain, rapid breathing, fruity breath). Note that DKA can occur even when glucose is near-normal in people on SGLT2-inhibitor medications, so symptoms -- not just a high reading -- should prompt the call [7]Source: Hyperglycemic Crises in Adults With Diabetes — ADA/EASD Consensus (Diabetes Care 2024;47(8):1257) — American Diabetes Association / EASD.

How is glucagon used in a diabetic emergency?

Glucagon is injected into the thigh or upper arm of an unconscious hypoglycemic patient who cannot swallow. Family members and close contacts of insulin-dependent diabetics should be trained on its use before an emergency occurs.

What precautions should diabetic patients take when traveling?

Carry at least one week's extra medication supply, keep insulin in a temperature-controlled case, bring a blood glucose meter with extra test strips, carry a medical ID card, and research the nearest hospital at your destination.