Diabetic Attacks and Emergencies

In people with type 1 diabetes, their pancreas doesn’t make any insulin; in those with type 2 diabetes, it doesn’t make enough.1

Healthy blood sugar levels are between 60 and 140 mg/dL. A blood glucose of above 140 mg/dL is considered too high, and one that’s below 60 mg/dL is too low. Having high blood sugar for a long period of time puts people with diabetes at risk for other health problems, such as kidney disease, heart disease, stroke, and nerve damage.1 Another common issue that people living with diabetes face is diabetic emergencies.

ypes of Diabetic Emergencies

A diabetic emergency happens when blood sugar is too high or too low for too long. This is a life-threatening condition that requires immediate medical treatment. There are a few types of diabetic emergencies, and some conditions may increase the risk of a diabetic emergency.2

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) occurs when the body begins burning fat, instead of sugar, for fuel. This happens when there isn’t enough insulin to deliver sugar to cells for energy. To make up for this, the liver begins breaking down fat too quickly for the body to process. This can lead to a buildup of ketones (a type of acid) in the blood, which can become poisonous.3

Symptoms of DKA can include:

• Rapid breathing
• Flushed face
• Nausea, vomiting, or abdominal pain
• Decreased alertness
• Frequent urination or thirst that lasts for a day or more
• Dry skin or mouth
• Muscle stiffness or aches
• Dehydration
• Headache
• Fruity breath

DKA is most common in individuals with type 1 diabetes. It can sometimes be the first sign of type 1 in those who are not diagnosed. Causes of DKA in type 1 diabetes include infection, injury, serious illness, missed insulin doses, or stress due to surgery.3

DKA is less common in people with type 2 diabetes. If it occurs, it is typically less severe. Causes of DKA in type 2 diabetes include uncontrolled high blood sugar for a long period of time, missing medicine doses, or a severe illness or infection.

Hypoglycemia

When you eat too much sugar, the excess is stored in the muscles and liver. When blood sugar decreases, the liver releases what it has stored, raising the amount of sugar in the blood. For some, especially those with diabetes, their blood sugar doesn’t go up enough and is below 70 mg/dL, causing hypoglycemia, or low blood sugar.2

Possible symptoms of hypoglycemia include:

• Fast breathing
• Sweating or chills
• Fast heartbeat
• Confusion
• Lightheadedness or dizziness
• Nausea
• Irritability
• Hunger
• Color draining from the skin
• Sleepiness
• Weakness
• Blurred vision
• Tingling or numbness in the lips, tongue, or cheeks
• Headaches
• Coordination problems
• Seizures

Hypoglycemia can happen to anyone, but for people with diabetes, hypoglycemia can occur as a side effect of the medicine they’re taking. Eating foods high in carbohydrates usually helps raise your blood sugar to normal levels. If hypoglycemia happens too often, they need to consult with their doctor to see if they need to change their treatment plan.

Hyperglycemia

Hyperglycemia is blood glucose greater than 125 mg/dL while fasting, which is defined as not eating for at least eight hours. It can occur in people with diabetes if they’re eating too many carbohydrates, taking their medicine incorrectly, or their medication is not as effective as it should be.5 Stress and the dawn phenomenon, a surge of hormones that lead to high blood sugar in the morning, could also lead to hyperglycemia.

 Symptoms of hyperglycemia can include:5

• Increased urination or thirst
• Headache
• Blurred vision
• Fatigue
• Slow-healing cuts and sores

Hyperglycemic hyperosmolar syndrome (HHS) can occur if you have a high blood sugar level for a long time.

Signs of HHS can include:6

• Blood sugar over 600 mg/dL
• Extreme thirst or dry mouth
• Confusion, hallucinations, drowsiness, or passing out
• Fever over 100.4 degrees F
• Weakness or paralysis on one side of the body
• Frequent urination
• Blurred vision

HHS usually develops in people who do not have their type 2 diabetes under control and who have an infection, stopped taking their medications, have a heart attack or stroke, or take medicine that can cause this condition, such as steroids and diuretics.

Increased Susceptibility to Infections

High blood sugar can negatively affect the immune system. It can lower the ability of white blood cells to come to the site of an infection and kill what is causing the infection. Nerve damage and difficulty breaking down and storing fats can contribute to an increased risk of infection.

People with type 1 or type 2 diabetes are vulnerable to infections that can become life threatening, including:

• Fungal infections, such as jock itch, athlete’s foot, ringworm, and vaginitis
• Urinary tract infections
• Bacterial infections of the skin and soft tissue that won’t heal

Signs of infection can include fever, chills, sore throat or mouth sores, redness or swelling, or pain with urination

Diabetic Coma

A diabetic coma, where a person passes out due to extremely low or high blood sugar, is an emergency that requires immediate medical attention. Because extreme hypoglycemia or hyperglycemia can cause a diabetic coma, symptoms of these two conditions could be signs of a diabetic coma.

Other circumstances can also increase the risk of diabetic coma, such as:

• Surgery or other bodily trauma
• Illness or infection
• Drinking alcohol
• Skipping insulin doses
• Poor diabetes management

Diabetic ketoacidosis or hypoglycemia are more likely to cause a diabetic coma in those with type 1 diabetes, while HHS places people with type 2 diabetes more at risk of this condition.

Preeclampsia

Preeclampsia is pregnancy-induced high blood pressure (hypertension) and liver or kidney damage. It often occurs after the 20^th week of pregnancy. The risk of preeclampsia is two to four times higher among people with type 1 or type 2 diabetes.

The exact cause of preeclampsia is unknown. It is estimated to occur in about 3% to 7% of all pregnancies.12

Women with preeclampsia often do not feel sick, but symptoms could include:

• Swelling of the hands and face or eyes
• Sudden weight gain over one to two days or more than two pounds a week
• Headache that does not go away or becomes worse
• Trouble breathing
• Belly pain on the right side, below the ribs
• Not urinating very often
• Nausea and vomiting
• Vision changes, such as temporary blindness, seeing flashing lights or spots, sensitivity to light, and blurry vision
• Feeling lightheaded or faint

Heart Attack or Stroke

Even when diabetes is controlled, high blood sugar can still damage the blood vessels and nerves of the heart over the years. The longer you have diabetes, the higher the chances that you will develop heart disease. This increases the risk of heart attack or stroke.

Signs of a heart attack can include:13

• Pain or pressure in your chest that lasts longer than a few minutes or goes away and returns
• Pain or discomfort in one or both arms, or the shoulders, back, neck, or jaw
• Shortness of breath
• Sweating or lightheadedness
• Feeling extreme fatigue
• Indigestion or nausea

Women are more likely to experience nausea or vomiting, back or jaw pain, and shortness of breath as heart attack symptoms.14

Signs of a stroke are:

• Sudden numbness or weakness on one side of the body
• Trouble seeing or walking
• Sudden severe headaches with no known cause
• Confusion, difficulty speaking or understanding speech

If you experience any of these symptoms, call your doctor immediately.

Prevention

To avoid a diabetic emergency, you must manage your diabetes as well as possible. Check your blood sugar often, and get into the habit of recognizing the early signs that levels are rising or dropping toward a dangerous range.

Other tips to prevent a diabetic emergency include:

• Eat regularly and avoid foods that are processed or have added sugar
• Stay active and exercise regularly
• Take medications as prescribed

It’s also a good idea to carry snacks that you can eat to quickly get sugar into your blood to treat hypoglycemia. These might include raisins, candy, or glucose tablets.

For hyperglycemia, exercise will lower your blood sugar, but if your blood sugar is above 240 mg/dL, you need to check your urine for ketones. Exercising with a high ketone level will raise your blood sugar even higher.