Diabetic Emergencies: A Guide to Prevention and Treatment

Diabetes is a serious condition, but it can be controlled and normalised. In uncontrolled scenarios, the three major significant consequences of diabetes are diabetic ketoacidosis, hypoglycaemia, and hyperglycaemic hyperosmolar state. These three represent the points of inadequate management of blood sugar levels. The risk of these consequences can be significantly decreased by educating the patient and their families and using the available treatment options.

Understanding Diabetic Emergencies

When your blood glucose, often known as blood sugar, is measured as too high for a long period of time, you have diabetes Normally, our bodies can maintain correct blood sugar (glucose) levels as the sugar in the blood is absorbed into the body cells with the help of insulin. The sugar is further converted into energy by the cells. However, in people with diabetes, due to less or no insulin secretion in their body, blood sugar cannot be absorbed into the body cells and sugar levels in the blood increase. Therefore, modifications in diet, medications, or insulin injections need to be used to control blood sugar levels.

People with diabetes may occasionally have a diabetic crisis that needs immediate attention.

Diabetes-related emergencies include:  

• Diabetic ketoacidosis (DKA)
• Hyperosmolar hyperglycaemic state (HHS)
• Hypoglycaemia (blood sugar levels below the normal range)

DKA and HHS are hyperglycaemic states, in which blood sugar levels are above the normal range.

Out of the three diabetes-related emergencies mentioned above, the most common diabetes emergencies are DKA and hypoglycaemia. HHS, although less prevalent, has a higher risk of death as compared to the other two states.4

What Is Diabetic Ketoacidosis?

Let us not take DKA casually. It is a life-threatening condition that has the potential to result in diabetic coma or even death.  Let us understand how it happens.

When the body cells cannot absorb and use glucose, they break down fat to use as fuel. As your body starts burning fat for energy, ketones are produced. The blood becomes more acidic with a high level of ketones. This indicates an underlying illness or uncontrolled diabetes.

The symptoms of DKA include:

• Feeling unusually thirsty or having a dry mouth even after drinking water
• Urinating frequently
• Feeling perpetually exhausted
• Flushed or dry skin
• Abdominal discomfort
• Vomiting or nausea for no other reason
• Trouble breathing
• Fruity breath odour
• Confusion or trouble paying attention during routine work

Immediately contact your doctor if you happen to have any of the mentioned symptoms or visit the emergency room in the hospital closest to you.

What Is Hyperosmolar Hyperglycaemic State?

HHS, according to the American Academy of Family Physicians (AAFP), is when the blood sugar levels are dangerously high, often exceeding 600 mg/dl. This condition might be fatal and could occur with or without DKA. HHS is more common in those with type 2 diabetes that is poorly managed.

The following elements, according to the AAFP, might raise the risk of HHS:

• Using medications that can cause dehydration, for example, some psychiatric medications
• Failing to treat diabetes or having undiagnosed diabetes
• Abusing certain substances
• Medical conditions such as a lung clot, past history of heart attack, or stroke

Early signals of danger include:

• Dry mouth
• A fast, erratic pulse
• Seizures
• An unconscious state
• Momentary limb paralysis
• Blood sugar levels that are higher than 600 mg/dl

If someone exhibits these signs, they must seek immediate medical attention. They will need to be treated at the hospital, and treatment will involve rehydrating them, administering insulin, and providing essential care for the underlying condition, if any.

What Is Hypoglycaemia?

It is normal for your blood glucose levels to increase or decrease during the day based on many factors. You probably won't even notice a variation unless there is a marked fluctuation in your blood glucose level. However, if blood glucose levels fall below the lower limit of the healthy range (hypoglycaemia), it can be dangerous. This usually happens when blood sugar is less than 70 mg/dl.

In such situations, you need to take the necessary steps to bring your blood sugar back to a normal range immediately. Low blood sugar levels may lead to seizures and may be fatal if left untreated. Symptoms are easier to manage if you are aware of them.

Although hypoglycaemia can happen for a variety of reasons, it often results from using unregulated doses of insulin or other blood sugar-regulating drugs. 

Some common causes of hypoglycaemia include:

• Using more insulin than is necessary for the current dietary intake or degree of activity
• Overindulgence in alcohol
• Skipping or delaying meals and exercising more than anticipated

Hypoglycaemia can cause symptoms such as:  

• Disorientation, dizziness, nausea, feelings of hunger and shakiness, nervousness, irritability, or anxiety.
• Fast pulse, exhaustion, and weakness
• Tingling sensation around the mouth
• Headaches
• Seizures
• Unconsciousness

When experiencing these symptoms, if blood sugar is checked, you may discover your blood sugar levels are below 70 mg/dl.

To tackle the above symptoms on your own, you should consume a high-carbohydrate snack, such as a sweet or one sugar cube. However, if you lose consciousness, emergency medical assistance is needed.

Conclusion

A medical emergency can happen for several reasons in a person with diabetes. However, excessively elevated or decreased blood glucose levels or high ketone levels may be fatal if not treated right away.  

The likelihood of an emergency in a person with diabetes can be decreased by managing it with medicines and a healthy lifestyle, making sure that your near and dear ones are aware of your condition, and learning as much as you can about diabetes and its consequences.