Diabetic Emergencies and EMS

Diabetic emergencies are one of the most common reasons for calls to 911 for Emergency Medical Services.  The incidence of diabetes is increasing in our society and the associated complications can be life-threatening.  The following situations can become 911 medical emergencies and warrant an immediate call for Emergency Medical Services:

• The person with a severe diabetic complication should receive care via EMS.
• A companion should go along to speak for the person if the person is not able to speak for himself or herself with the emergency care professional.
• Bring a list of medical problems, medications, allergies to medications, and the person's blood sugar diary to the emergency department or ambulance. This information will help the emergency care professional diagnose the problem and treat it appropriately.

The following are signs and symptoms of diabetic complications that warrant emergency care.

• Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels. If a person has diabetes with an altered mental status:
  • Try giving them some fruit juice (about 6 ounces) or cake icing if the person is awake enough to swallow normally without choking. Avoid giving things such as hard candy that can lodge in the throat. The health care provider can prescribe glucose wafers or gels that melt under the tongue.
  • Does not wake up and behave normally within about 15 minutes, call 911.
  • Is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.
• Nausea or vomiting: If the patient is known to have diabetes and cannot keep food, medications, or fluids down at all, they may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes. If the person:
  • Has not already taken the latest insulin dose or oral diabetes medicine, do not take it without talking to a medical professional.
  • Already has low blood sugar levels, taking additional insulin or medication will drive the blood sugar level down even further, possibly to dangerous levels.
• Fever above 101.5 F (38.6 C): If the primary health care professional cannot see the patient right away, seek emergency care for a person with diabetes with a high fever. Note any other symptoms such as cough, painful urination, abdominal pain, or chest pain.
• High blood sugar level: If the patient's blood sugar level is above 400 mg/dL, and the primary health care professional cannot see them right away, go to the closest emergency department. Very high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of diabetes the person has. Both of these conditions can be fatal if not treated promptly.
• Large sores or ulcers on the feet or legs: If the person has diabetes, a non-healing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.
  • Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or leg.
  • If left untreated, such a sore may ultimately require amputation of the limb.
• Any cut penetrating all the layers of skin, especially on the legs, is a potential danger to a person with diabetes. Proper wound care although important to anyone's recovery, is especially important in diabetics to assure proper wound healing.
• Chest pain: If the person has diabetes, take very seriously any pain in the chest, particularly in the middle or on the left side, and seek medical attention immediately.
  • People with diabetes are more likely than non-diabetic people to have a heart attack, with or without experiencing chest pain.
  • Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.