Severe Hypoglycemia and Hyperglycemia from Diabetes Medications: Emergency Care Protocols

What Counts as a Diabetes Emergency?

When your blood sugar drops too low or spikes too high, it’s not just uncomfortable-it’s dangerous. Severe hypoglycemia means your blood glucose is below 54 mg/dL (3.0 mmol/L) and you can’t treat yourself. You need someone else to step in. Severe hyperglycemia isn’t just a high number-it’s diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), both of which can kill you if not treated fast. DKA usually shows up with blood sugar over 250 mg/dL, ketones in your blood, and acid in your system. HHS hits even harder: sugar levels above 600 mg/dL, extreme dehydration, and thick, syrupy blood. These aren’t minor blips. They’re medical crises that demand immediate action.

Glucagon: Your Lifeline for Low Blood Sugar

If you’re on insulin and your blood sugar crashes, glucagon is the only thing that can save you when you’re unconscious or too confused to swallow. For years, the only option was a messy kit: freeze-dried powder, a syringe, mixing it up, then injecting. Most people never learned how. A 2021 study found only 42% of caregivers could use it right. That’s why new forms changed everything. Baqsimi is a nasal spray-just stick it in one nostril and press. Gvoke is a ready-to-use autoinjector like an EpiPen. Both work in under 15 minutes. No mixing. No needles. No panic. The FDA approved Baqsimi in 2019 and Gvoke in late 2019. Now, 85% of endocrinologists recommend these over the old kit. They’re easier, faster, and more reliable. If you’re on insulin, you need one. Not someday. Now.

What Happens If You Give Glucagon to Someone With High Blood Sugar?

It’s a deadly mistake. Glucagon raises blood sugar. If someone is in DKA or HHS, their body is already drowning in glucose and ketones. Giving glucagon makes it worse. It can push them into coma or cardiac arrest. On the flip side, giving insulin to someone with severe hypoglycemia is just as bad. It drops their sugar even lower. You can’t guess. You have to know. If someone is unconscious, don’t assume it’s low sugar. Don’t give insulin. Don’t pour juice down their throat. Call 911. If you have a glucose meter, check it. If you don’t, and you’re not 100% sure, wait. Administer glucagon only if you’re certain it’s hypoglycemia. The American Diabetes Association says: if you can’t measure, don’t medicate. Better to wait than to kill.

How to Treat High Blood Sugar Emergencies

Hyperglycemic emergencies don’t respond to pills or insulin shots at home. They need hospital care. The goal is threefold: rehydrate, replace electrolytes, and lower sugar slowly with IV insulin. First, fluids-usually 1 to 2 liters of saline in the first hour. Then, potassium. When insulin starts working, it drives potassium into cells. If your levels are already low, you can crash. Doctors add 20-30 mEq of potassium chloride to the IV drip. Insulin goes in as a steady IV drip-not a bolus. Too much too fast can cause brain swelling. For mild DKA (pH above 7.0), some doctors now use fast-acting insulin like lispro under the skin, but only if the patient is alert and stable. For severe cases, IV is still the rule. Blood ketone testing is now standard in ERs. If your ketones are above 1.5 mmol/L, go to the hospital. Don’t wait. Don’t try to “tough it out.”

Why People Delay Treatment-And What You Can Do

A T1D Exchange survey found that 58% of people wait more than 12 hours before seeking help during a hyperglycemic crisis. Why? They think it’s just “a bad day.” They don’t recognize the early signs: extreme thirst, frequent urination, nausea, fruity breath, confusion. Others fear the hospital. Or they don’t have a plan. A 2022 Beyond Type 1 survey showed 63% of type 1 patients had experienced severe low blood sugar, but only 41% always carried glucagon. Fear of using it wrong was the top reason. Training fixes this. A 30-minute video can boost successful glucagon use from 32% to 89%. Practice quarterly with a training device. Keep your kit in your bag, your car, your child’s backpack. Label it. Teach your partner, your kids, your coworker. Make it normal. If your school nurse refuses to use glucagon, get a written emergency plan. You have rights.

What Should Be in Your Emergency Kit?

Forget the old-school glucagon kit unless you’re trained and willing to practice. Go for the nasal spray or autoinjector. Your kit should include: one ready-to-use glucagon device (check expiration date), glucose tablets (4g each-exactly 15g for mild lows), a small bottle of regular soda (not diet), a glucose meter with extra strips, ketone test strips, and a printed emergency card with your name, diagnosis, insulin type, emergency contacts, and doctor’s number. Keep it in your purse, your car, your child’s backpack. Check it every three months. Expired glucagon won’t work. Wet strips give false readings. Replace what’s old. Don’t wait for a crisis to find out your kit is useless.

What’s New in 2025?

The biggest breakthrough isn’t a drug-it’s a system. The Beta Bionics iLet, a dual-hormone artificial pancreas, got FDA approval in 2023. It automatically delivers tiny doses of glucagon when it predicts a low. In trials, it cut severe hypoglycemia by 72%. But it’s not widely available yet-only 12 U.S. centers offer it. Still, it’s the future. Companies like Eli Lilly now link glucagon devices to apps. The Gvoke HelperApp walks you through each step with video. It even reminds you to replace your device before it expires. In 2025, expect more integration: CGMs that auto-alert 911, smart pens that track insulin use, and insurance plans that cover glucagon without prior authorization. But for now, the best tool is still knowledge. Know your numbers. Know your signs. Know how to use your glucagon. That’s what saves lives.

Who’s at Risk-and Why It’s Not Fair

Black and Hispanic patients with diabetes are 2.3 times more likely to be hospitalized for severe hypoglycemia than white patients. Why? Access. Cost. Education. Medicaid patients face prior authorization for glucagon 31% of the time. Private insurance? Only 12%. The new glucagon devices cost $250-$270. The old kit is $130-but if you can’t use it, it’s useless. Insurance won’t cover it if you’re on Medicare Part D and don’t have a prescription on file. You need to ask for it. Demand it. If your doctor says, “You probably won’t need it,” push back. The ADA says: everyone on insulin should have glucagon. Period. If you’re on SGLT2 inhibitors like Farxiga or Jardiance, you’re at risk for DKA even with normal blood sugar. Know the signs. Test for ketones if you’re sick. Don’t wait. This isn’t just about medicine. It’s about justice. Your life matters. Your access should too.