Diabetes Emergency Decision Checker
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Answer these critical questions to determine the correct emergency response.
Emergency Response
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.
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
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:- Get a prescription for glucagon-preferably nasal spray or autoinjector.
- Watch the ADA’s free glucagon training video.
- Practice with a trainer device every 3 months.
- Teach at least two people how to use it.
- Check ketones if blood sugar is over 250 mg/dL.
- Call 911 if someone is unconscious, confused, or vomiting with high blood sugar.
Can you give glucagon to someone with high blood sugar?
No. Giving glucagon during severe hyperglycemia can make blood sugar rise even higher, worsening diabetic ketoacidosis or hyperosmolar hyperglycemic state. Glucagon only works to raise low blood sugar. If you’re unsure whether someone has high or low blood sugar, do not give glucagon-call 911 instead.
What should you do if someone with diabetes passes out?
Call 911 immediately. Then administer glucagon if you have it and know how. Do not try to give them food, drink, or pills. If they’re unconscious, anything in their mouth could cause choking or aspiration. Place them on their side if possible. Wait for emergency responders.
Is it safe to use expired glucagon?
It’s better than nothing-but not ideal. Studies show expired glucagon can still work, especially nasal sprays and autoinjectors, but effectiveness drops over time. If you have no other option during an emergency, use it. But replace it before expiration. Always check the date on your kit.
Can type 2 diabetes patients get severe hypoglycemia?
Yes. While less common than in type 1, people with type 2 diabetes who take insulin or sulfonylureas like glimepiride or glyburide are at real risk. One in four type 2 patients on insulin will have a severe low at least once. They should carry glucagon too.
How do you know if high blood sugar is turning into an emergency?
Look for symptoms beyond just high numbers: nausea, vomiting, abdominal pain, fruity-smelling breath, deep rapid breathing, confusion, or extreme fatigue. If your blood sugar is over 250 mg/dL and you have ketones above 1.5 mmol/L, treat it as an emergency. Go to the ER. Don’t wait.
Why isn’t glucagon prescribed more often?
Many doctors still think it’s only for type 1 patients or assume patients won’t use it. But the ADA now says: everyone on insulin should have glucagon. Cost and insurance barriers also play a role. Medicaid patients face more hurdles than those with private insurance. Advocacy and education are needed to change this.
Can you use glucagon if you’re not a healthcare professional?
Yes. Nasal glucagon and autoinjectors are designed for non-medical users. The instructions are simple: insert and press. No mixing, no syringes. Training videos from the ADA and manufacturers make it easy. Family, teachers, coworkers-anyone can learn to use it.
What’s the difference between DKA and HHS?
DKA usually happens in type 1 diabetes and involves ketones and acid in the blood (pH below 7.3). HHS is more common in type 2 and involves extreme dehydration and very high blood sugar (over 600 mg/dL), but little to no ketones. Both are emergencies, but HHS has higher mortality if untreated.