Diabetic Emergencies
In 10 minutes you'll know how to tell a low blood sugar emergency from a high one, and exactly what to do for each.
Print this course — or save it as a PDF from the print dialog. Good for a fridge, a glovebox, or a waiting room.
Why this matters
Blood sugar swings happen fast, and severe ones are medical emergencies. Diabetes is one of the most common chronic conditions in the United States (Centers for Disease Control and Prevention), and for anyone living with it, blood sugar can drop or spike hard enough to become dangerous within minutes. The right response depends on one question: is the person conscious and able to swallow?
Know the signs
Low blood sugar is the fast killer
Low blood sugar (hypoglycemia) can develop in minutes, and it is the more dangerous direction for someone taking insulin or certain diabetes medications. Watch for sudden shakiness, heavy sweating, confusion, irritability or sudden anger, and slurred speech. The brain runs on sugar, and when the level drops too far, it stops working the way it should — fast.
These signs can also include hunger, a fast heartbeat, or looking pale and unsteady on their feet. The pattern that matters most is how sudden it is: someone who was fine minutes ago and is now confused or acting strangely.
It can look exactly like being drunk
This is the danger that catches bystanders off guard. Slurred words, stumbling, sudden mood swings, even combativeness — low blood sugar can look exactly like intoxication, and it happens in people who have not had a drop of alcohol. A coworker, a stranger on a bus, a classmate: if someone is acting "drunk" and it does not add up, low blood sugar belongs on the list.
Look for a medical-ID bracelet or necklace, or ask if they have diabetes, before assuming the worst about someone. Getting this wrong — walking away from a medical emergency because it looked like drunkenness — is exactly the mistake this course exists to prevent.
Conscious and can swallow: give fast sugar
If the person is awake, alert enough to follow directions, and able to swallow safely, give fast-acting sugar right away: juice, regular soda (not diet), or glucose tablets if they carry them. Have them sit down while they take it.
Recheck how they feel after about 15 minutes. Most people improve within that window. If they are still shaky, confused, or off, give another round of fast sugar and check again. If they are not improving after a second try, or you are ever unsure, call 911.
When someone is unconscious or cannot swallow
Never put food or drink in the mouth of someone who is not fully alert — they could choke or breathe it into their lungs. If the person is unconscious, having trouble staying awake, or cannot swallow safely, call 911 first.
While you wait, turn them onto their side in the recovery position so their airway stays clear if they vomit. Stay with them and keep talking, even if they cannot answer. Some people with diabetes carry a glucagon kit for exactly this situation — if you are often with someone who carries one, ask them to show you how theirs works ahead of time, before you ever need it.
High blood sugar can be an emergency too
High blood sugar usually builds up over hours or days, but it can turn into a genuine emergency called diabetic ketoacidosis, or DKA. Watch for breath that smells fruity or like nail polish remover, deep and rapid breathing, vomiting, belly pain, and confusion.
Any of those together, especially the fruity breath and fast breathing, means call 911. This can happen in someone whose diabetes was never diagnosed, so it is not only a risk for people who already know they have it.
How it really looks
The coworker who seemed drunk before lunch
Doreen notices her coworker snapping at a customer over nothing, slurring his words, and swaying slightly by the register. Someone mutters that he must have been drinking at his desk. Doreen has worked with him for two years and knows he wears a medical-ID bracelet for diabetes. She checks it, then gets him a juice box from the break room fridge and stays with him while he drinks it. Within ten minutes his words come back to normal and he remembers nothing about the last half hour. He is embarrassed, but grateful someone recognized what was actually happening instead of walking away.
Found unresponsive, insulin pump still running
Trevor's mother finds him in bed at 4 p.m. on a Saturday, unresponsive, his insulin pump still clipped to his waistband. He does not wake when she says his name or rubs his chest firmly. She does not try to get him to drink anything. She calls 911, tells the dispatcher he is a diabetic teenager who will not wake up, and rolls him onto his side while she waits, the way the dispatcher walks her through. Paramedics arrive within eight minutes and treat him for severe low blood sugar. He is groggy and confused in the ambulance, but he wakes up.
What to do until help arrives
- Check if they can swallow safely. If they are awake and alert, that answers the first and most important question.
- If conscious, give fast sugar right away: juice, regular soda, or glucose tablets.
- Recheck in 15 minutes. Give a second dose of fast sugar if they are still off, and call 911 if there is no improvement.
- If unconscious or unable to swallow, call 911 immediately and give nothing by mouth.
- Turn them into the recovery position on their side, and stay with them until help arrives.
- Tell the dispatcher or paramedics it may be diabetes-related, and mention any medical-ID bracelet, insulin pump, or glucagon kit you see.
Myths & mistakes
People often think someone acting drunk and confused is just drunk, and it's not your business.Actually low blood sugar can look identical to intoxication. If someone is acting strangely and it doesn't add up, check for a medical-ID bracelet or ask before you assume.
People often think you should let someone with low blood sugar sleep it off.Actually sleep can hide a dropping blood sugar getting worse. If they are hard to wake or cannot answer clearly, that is unconsciousness, not sleep, and it means call 911.
People often think giving food or water to someone who is unconscious will help them.Actually anything by mouth risks choking when someone is not fully alert. If they cannot swallow safely on their own, give nothing by mouth and call 911 instead.
What you learned
- The question that matters most: is the person conscious and able to swallow safely?
- Conscious and swallowing: give fast sugar — juice, regular soda, or glucose tablets — and recheck in 15 minutes.
- Unconscious or can't swallow: call 911, give nothing by mouth, and use the recovery position.
- Low blood sugar can look exactly like drunkenness. A medical-ID bracelet is a clue worth checking.
- Fruity breath, rapid breathing, vomiting, and confusion together can mean high blood sugar has become an emergency — call 911.
Sources
- American Diabetes Association — Hypoglycemia (low blood sugar) and hyperglycemia emergencies
- Centers for Disease Control and Prevention — Diabetes: managing blood sugar emergencies
Spot an error? Tell us — accuracy matters more to us than being fast.
Common questions
What if I'm not sure whether it's low or high blood sugar?
You don't have to tell them apart. If the person is awake and can swallow, fast sugar is safe and it won't meaningfully worsen high blood sugar in the short time before help can sort it out. If they are unconscious, confused, or can't swallow, skip guessing and call 911.
Is it okay to give a diabetic coworker food if I'm not sure what's wrong?
Yes, as long as they are awake, alert, and can swallow on their own. Juice, regular soda, or glucose tablets are safe choices. Never give food or drink to someone who is drowsy, confused enough that they can't follow simple directions, or unconscious — call 911 instead.
What is glucagon, and do I need to carry it?
Glucagon is an emergency medication some people with diabetes carry for severe low blood sugar, used when someone can't take sugar by mouth. You don't need to carry your own, but if you're often with someone who has a kit, it's worth asking them to walk you through how theirs works before an emergency happens.
Check what you know
Five questions. Four correct to pass. Retake as many times as you like — this is practice, not a test.
Keep going
This course belongs to Everyday Emergencies. Courses that pair well with it:
From other readers
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