Severe Hypoglycemia and Hyperglycemia from Diabetes Medications: Emergency Care

When your blood sugar drops too low or spikes too high, it’s not just a nuisance-it’s a medical emergency. For people on insulin or certain diabetes medications, severe hypoglycemia and severe hyperglycemia can turn deadly in minutes. The difference between life and death often comes down to knowing what to do, and doing it fast.

What Counts as a Severe Emergency?

Severe hypoglycemia isn’t just feeling shaky or sweaty. It’s when your blood sugar falls below 54 mg/dL and you can’t treat yourself. You might pass out, have a seizure, or be too confused to swallow. This happens most often with insulin or sulfonylureas like glipizide. A 2019 JAMA study found that people with type 1 diabetes face a 30% chance of this happening every year.

Severe hyperglycemia isn’t just high numbers on a meter. It’s when your blood sugar climbs above 250 mg/dL and your body starts breaking down fat for energy, producing toxic ketones. This leads to diabetic ketoacidosis (DKA), or worse-hyperosmolar hyperglycemic state (HHS), where blood sugar can hit 600 mg/dL or higher. Both can cause coma or death if untreated.

Glucagon: The Lifesaver You Might Not Know How to Use

If someone with diabetes is unconscious or seizing from low blood sugar, you don’t give them juice. You don’t wait. You give glucagon. And it’s not the old, messy kit from the 90s anymore.

Today, you have three options:

• Baqsimi-a nasal spray you just stick in the nose and press. No needles. No mixing.
• Gvoke-a pre-filled autoinjector you jab into the thigh like an EpiPen.
• Traditional glucagon kit-powder you mix with liquid, then inject. Hard to do under stress.

A 2021 study showed 83% of caregivers could use the nasal spray correctly. Only 42% could handle the old kit. Time matters: nasal glucagon works in 10-15 minutes. Injectables take 15-20. And if you’re fumbling with vials while someone is seizing, you’re wasting precious seconds.

What NOT to Do in a Hypoglycemia Emergency

Never try to feed or give water to someone who’s unconscious. It’s a choking hazard. You might cause aspiration pneumonia-something that can kill faster than low blood sugar itself.

Also, don’t guess. If you’re not sure if it’s low or high blood sugar, don’t give insulin. Don’t give glucagon. Call 911. Giving insulin when blood sugar is already low can crash it further. Giving glucagon when blood sugar is sky-high can push it even higher.

The American Diabetes Association says: if you can’t measure blood sugar right away, wait. Call for help. Better to delay treatment than make a deadly mistake.

Hyperglycemia Emergency: It’s Not Just About Insulin

When someone has DKA or HHS, giving insulin isn’t enough. You need fluids. You need electrolytes. You need hospital care.

In the ER, doctors start with IV fluids-usually 1 to 2 liters of saline in the first hour. That’s because high blood sugar pulls water out of your cells, dehydrating you. Then they add potassium to fix dangerous imbalances. Finally, they give continuous IV insulin, slowly, to bring sugar down without crashing potassium levels.

Some people think: “I’ll just take more insulin at home.” That’s how people end up in the ICU with dangerously low potassium. One 2020 study found 12% of DKA cases were worsened by this exact mistake.

If you have type 1 diabetes and your blood sugar is over 250 mg/dL with ketones above 1.5 mmol/L, you need to go to the ER. Don’t wait. Don’t “see how it goes.” DKA can kill in hours without treatment.

Why People Don’t Act-Even When They Know Better

A 2022 survey by Beyond Type 1 found that 63% of people with type 1 diabetes had experienced a severe low requiring help. But only 41% carried glucagon. Why? Fear. They’re scared they’ll mess up.

And they’re not wrong to worry. A 2021 study showed that only 5% of prescribed glucagon kits were ever used-because people never learned how. The old kits were complicated. The training was rushed.

But now? There’s free video training from the ADA. A 30-minute video boosts success rates from 32% to 89%. Schools, workplaces, even family members can learn. Practice with a training device every few months. Skills stick if you use them.

What Should Be in Your Emergency Kit?

Your emergency kit isn’t just glucagon. It’s a full plan:

• Glucagon (nasal spray or autoinjector-check expiration date)
• Glucose tablets (15g total-4 tablets at 4g each)
• Fast-acting carbs (4 oz regular soda, 1 tube of glucose gel)
• Portable ketone meter and strips
• Emergency contact list with doctor, family, and 911 info
• Medical ID bracelet or card

Keep one at home. One in your bag. One at work or school. Make sure everyone who might be with you knows where they are.

Who’s at Highest Risk-and Who’s Being Left Behind

Type 1 diabetes patients are most at risk for severe lows. But type 2 patients on insulin are just as vulnerable. Yet only 34% of them carry glucagon, compared to 68% of type 1 patients.

Racial disparities are stark. A 2023 Health Affairs study found Black and Hispanic patients are 2.3 times more likely to be hospitalized for severe hypoglycemia than white patients. Why? Limited access to newer glucagon products. Insurance barriers. Fewer prescriptions from providers.

Medicaid patients face prior authorization for glucagon 31% of the time. Private insurance? Only 12%. That’s not just unfair-it’s deadly.

New Tech Is Changing the Game

The biggest breakthrough? The beta bionics ileft, the first dual-hormone artificial pancreas approved in 2023. It doesn’t just give insulin. It automatically releases tiny doses of glucagon when it predicts a low. In trials, it cut severe hypoglycemia by 72%.

But it’s not everywhere. Only 12 U.S. centers offer it right now. And it’s expensive.

Meanwhile, apps like Eli Lilly’s Gvoke HelperApp walk you through glucagon use with step-by-step videos. They’re free, easy, and linked to your prescription.

What You Can Do Today

If you or someone you care for takes insulin or diabetes pills that cause lows:

1. Get a prescription for glucagon-preferably nasal spray or autoinjector.
2. Watch the ADA’s free glucagon training video.
3. Practice with a trainer device every 3 months.
4. Teach at least two people how to use it.
5. Check ketones if blood sugar is over 250 mg/dL.
6. Call 911 if someone is unconscious, confused, or vomiting with high blood sugar.

This isn’t about being perfect. It’s about being ready. Because when your blood sugar crashes or soars, there’s no time to look things up. You act-or you lose.

Final Thought: Preparedness Saves Lives

You can’t control every low or spike. But you can control whether you’re ready. Glucagon isn’t a backup plan-it’s your first line of defense. Knowing the signs, having the right tools, and practicing what to do makes all the difference.

The next time someone says, “I don’t need glucagon,” ask them: What if it’s your child? Your partner? Your friend? Would you wait until it’s too late to learn how to save them?