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Diabetes: Emergency warning signs

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People with diabetes should wear or carry I.D. information (such as an alert bracelet) that emergency medical staff can find. They should always carry a sugar source, such as glucose tablets or raisins.

High ketones

Check for ketones using a simple urine test available at pharmacies. Perform this test every 4 - 6 hours if blood sugar goes above 240, or any time the person with diabetes is sick, unusually thirsty, has a dry mouth, is urinating frequently, or has vomited. Warning signs that ketoacidosis is getting serious:

  • Flushed face
  • Dry skin and mouth
  • Nausea or vomiting
  • Stomach pain
  • Deep, rapid breathing
  • Fruity breath odor

If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

Dangerously low blood sugar (Severe hypoglycemia)

Low blood sugar can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. It can develop quickly in people with diabetes. Symptoms of low blood sugar typically appear when the sugar level falls below 70. Watch for:

  • Weakness
  • Shaking
  • Sweating
  • Headache
  • Nervousness
  • Hunger

Monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.

If you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway --  it can't hurt. Symptoms should subside within 15 minutes. If the symptoms don't subside, more sugar should be eaten and the sugar level tested again.

AFTER the symptoms subside, more substantial food can be eaten. Use simple sugar FIRST to get the situation under control. Real food won't produce enough sugar and takes too long to digest.

Don't panic. Glucagon works very fast -- usually within 15 minutes. While you are waiting for the person to revive, keep him on his side to prevent choking. If the person is not better in 15 minutes, call 911.

Have glucagon stored for emergencies. Make sure everyone in your home, babysitters, and caregivers know how to use it. Periodically remind everyone how to use it. Check the expiration date.

References

American Diabetes Association. Standards of medical care in diabetes--2009. Diabetes Care. 2009 Jan;32 Suppl 1:S13-61.

Alemzadeh R, Wyatt DT. Diabetes mellitus in children. In: Kliegman RM, ed. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders;2007:chap 590.

Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kornenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 31.

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