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Managing blood sugar levels is a critical component of diabetes care, but even with careful attention, there are times when high blood sugar can become dangerous. Understanding when to seek medical help for uncontrolled high blood sugar can be lifesaving. This comprehensive guide will help you recognize the warning signs, understand the risks, and know exactly when to contact your healthcare provider or seek emergency care.
Understanding High Blood Sugar (Hyperglycemia)
Hyperglycemia happens when there’s too much sugar (glucose) in your blood, also called high blood sugar or high blood glucose. While occasional mild episodes of high blood sugar are common for people with diabetes, hyperglycemia can be potentially dangerous if blood sugar levels become very high or stay high for long periods.
For a person with diabetes, hyperglycemia is usually considered to be a blood glucose level greater than 180 mg/dL one to two hours after eating. However, your target blood sugar goals may vary depending on your individual circumstances, age, and overall health status.
Hyperglycemia usually doesn’t cause symptoms until blood sugar (glucose) levels are high — above 180 to 200 milligrams per deciliter (mg/dL), or 10 to 11.1 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks, and the longer blood sugar levels stay high, the more serious symptoms may become.
Life-Threatening Emergency: Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is serious and can be life-threatening. This condition represents one of the most critical complications of uncontrolled high blood sugar and requires immediate medical attention.
What Is Diabetic Ketoacidosis?
DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy, so instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.
DKA is most common among people with type 1 diabetes, but people with type 2 diabetes can also develop DKA. Without treatment, DKA is fatal.
How Quickly Can DKA Develop?
Diabetic ketoacidosis symptoms often come on quickly, sometimes within 24 hours. It can develop within 24 hours, and if you’re vomiting, it could develop much more quickly. This rapid onset makes it crucial to recognize the warning signs early.
Emergency Symptoms of DKA
If you experience any of the following symptoms, seek immediate medical attention by calling 911 or going to the nearest emergency room:
- Fruity-scented breath
- Being short of breath or rapid breathing
- Being confused or mental confusion
- Being weak or tired or severe weakness
- Feeling a need to throw up and throwing up
- Having belly pain
- Being very thirsty and urinating often
If it’s not treated, diabetic ketoacidosis can lead to death. High ketones can be an early sign of DKA, which is a medical emergency, so call 911 or go to the emergency room right away.
Testing for Ketones
If you have diabetes and you’re sick or your blood sugar is 250 mg/dL or above, you’ll need to check your blood sugar every 4 to 6 hours and check your urine for ketones. Ketone test kits are affordable and widely available over the counter to check your ketones at home.
If your blood glucose is above 240 mg/dl, check your urine for ketones, and if you have ketones, do not exercise as exercising when ketones are present may make your blood glucose level go even higher.
Another Serious Complication: Hyperosmolar Hyperglycemic State (HHS)
While DKA is more common in type 1 diabetes, people with type 2 diabetes can develop another dangerous condition called hyperosmolar hyperglycemic state (HHS). DKA and HHS are medical emergencies that are treated with intravenous fluids, electrolytes, and insulin.
HHS typically develops when extremely high blood sugar levels lead to severe dehydration. This condition can be just as dangerous as DKA and requires immediate emergency medical care.
When to Contact Your Healthcare Provider
Not every instance of high blood sugar requires emergency care, but there are specific situations when you should contact your healthcare provider promptly.
Persistently Elevated Blood Sugar Levels
If your blood sugar is 250–300 mg/dL or higher, call your doctor as they may need to adjust your medication or insulin. Consistently high readings despite following your treatment plan indicate that your current diabetes management strategy needs adjustment.
Your blood glucose levels stay above 240 milligrams per deciliter (mg/dL) (13.3 millimoles per liter (mmol/L)) and you have symptoms of ketones in your urine. This combination of high blood sugar and ketones requires immediate medical attention.
Blood Sugar Readings That Require Medical Attention
Understanding blood sugar ranges can help you determine when to seek help:
- More than 250-300 mg/dL: Symptoms become more pronounced and you should contact your doctor
- 300-400 mg/dL: This is an emergency, contact your doctor immediately
- More than 600 mg/dL: Severe, life-threatening risk of complication known as diabetic ketoacidosis (DKA)
If your blood sugar levels reach 240 mg/dL or higher, seek medical care to bring it back down safely.
When Treatment Isn’t Working
If you experience hyperglycaemia regularly, speak to your doctor or diabetes care team as you may need to change your treatment or lifestyle to keep your blood sugar levels within a healthy range.
If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider who can help you make changes to better manage your diabetes.
Common Warning Signs and Symptoms
Recognizing the symptoms of high blood sugar early can help you take action before the situation becomes critical. However, it’s important to note that some people who’ve had type 2 diabetes for a long time may not show any symptoms despite high blood sugar levels.
Early Warning Signs
The early symptoms of hyperglycemia include:
- Increased thirst and frequent urination: Increased thirst (polydipsia) and/or hunger, and frequent urination (peeing) are among the most common early signs
- Fatigue: Unexplained tiredness or feeling weak
- Blurred vision: High blood sugar can affect your eyesight temporarily
- Headaches: Persistent headaches may indicate elevated blood sugar
- Difficulty concentrating: Mental fog or trouble focusing
You should see your healthcare provider if you or your child is experiencing these symptoms, as the glucose level at which people with diabetes start to experience symptoms varies.
Progressive Symptoms
As blood sugar levels continue to rise or remain elevated, additional symptoms may develop:
- Dry mouth and dry skin
- Slow-healing cuts or sores
- Frequent infections, particularly skin, gum, or urinary tract infections
- Unexplained weight loss
- Increased hunger despite eating
- Nausea or vomiting
- Abdominal pain
Special Situations Requiring Medical Attention
During Illness or Infection
If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often and you also might need to check for urine ketones. Illness can cause blood sugar levels to spike unpredictably, even if you’re following your usual diabetes management plan.
Contact your healthcare provider if:
- You’re throwing up and can’t keep down food or liquid
- You have a fever that persists
- Your blood sugar remains elevated despite taking your usual medications
- You’re unable to eat or drink normally
First-Time Diagnosis
For some, these symptoms may be the first sign of diabetes. Symptoms of hyperglycaemia can also be due to undiagnosed diabetes, so see your GP if this applies to you as you can have a test to check for the condition.
If you don’t have a diabetes diagnosis but are experiencing symptoms of high blood sugar, especially if accompanied by unexplained weight loss, extreme thirst, or frequent urination, seek medical evaluation promptly.
Medication or Insulin Pump Issues
If you have insulin-dependent diabetes, forgetting or not taking insulin can cause DKA, and insulin pump issues like a kinked cannula or a disconnected site/tubing can prevent insulin from getting into your body.
If you use an insulin pump, check often to see that insulin is flowing through the tubing and make sure the tube is not blocked, kinked or disconnected from the pump.
Long-Term Complications of Uncontrolled High Blood Sugar
While immediate emergencies like DKA require urgent attention, chronically elevated blood sugar levels can lead to serious long-term health complications. Understanding these risks emphasizes the importance of maintaining good blood sugar control and seeking medical help when needed.
Cardiovascular Complications
Prolonged high blood sugar damages blood vessels and increases the risk of heart disease, stroke, and high blood pressure. The excess glucose in the bloodstream can cause inflammation and plaque buildup in arteries, leading to atherosclerosis.
Nerve Damage (Neuropathy)
High blood sugar can damage the tiny blood vessels that nourish your nerves, especially in the legs and feet. This can cause tingling, numbness, burning, or pain that typically begins at the tips of the toes or fingers and gradually spreads upward.
Kidney Damage (Nephropathy)
The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system, potentially leading to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
Eye Damage (Retinopathy)
Diabetes can damage the blood vessels of the retina, potentially leading to blindness. It also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
Foot Problems
Feet problems caused by damaged nerves or poor blood flow can lead to serious skin infections, ulcerations and, in some severe cases, amputation. Regular foot care and prompt attention to any cuts, blisters, or sores is essential.
Preventing High Blood Sugar Emergencies
While knowing when to seek help is crucial, prevention is equally important. Here are key strategies to help prevent dangerous blood sugar spikes:
Regular Blood Sugar Monitoring
Monitor your blood sugar by checking and recording your blood sugar level several times a week or several times a day depending on your treatment plan, as careful monitoring is the only way to make sure that your blood sugar level stays within your target range.
If you have diabetes, you’ll most likely need to check your blood glucose every day and make sure that it’s not too high, which you can do with a blood glucose meter or continuous glucose monitoring (CGM) system.
Medication Adherence
Carefully follow your health care provider’s directions for how to take your medication. Never skip doses of insulin or other diabetes medications without consulting your healthcare provider first.
Healthy Eating Plan
Follow your diabetes eating plan as it helps to eat smaller portions and avoid sugary beverages and frequent snacking, and if you’re having trouble sticking to your meal plan, ask your health care provider or dietitian for help.
Regular Physical Activity
Regular exercise is often an effective way to control blood sugar. However, don’t exercise if you have ketones in your urine as this can drive your blood sugar even higher.
Sick Day Management
Work with your healthcare team to develop a “sick day plan” that outlines what to do when you’re ill. This should include how often to check blood sugar, when to test for ketones, what foods and fluids to consume, and when to contact your healthcare provider.
What to Expect During Emergency Treatment
Understanding what happens during emergency treatment for severe hyperglycemia can help reduce anxiety if you or a loved one needs urgent care.
Emergency Room Care
If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital where emergency treatment can lower your blood sugar to a normal range.
Treatment Components
Your treatment will likely include replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood, replacing electrolytes (minerals in your body) as too little insulin can lower electrolytes, receiving insulin which reverses the conditions that cause DKA.
You’ll receive fluids — usually through a vein (intravenously) — until your body has the fluids it needs, which replaces fluids you’ve lost through urination and also helps dilute the extra sugar in your blood.
Hospital Admission
Treatment for DKA is complex, and patients with DKA need to be admitted to the hospital, often the intensive care unit, for careful monitoring for serious side effects, as in general, patients with DKA are very dehydrated and have a fluid deficit of 5% to 10% of their body weight, and these fluids need to be replaced with intravenous (IV) fluids.
Creating Your Personal Action Plan
Having a clear action plan can help you respond quickly and appropriately when blood sugar levels become concerning.
Know Your Target Ranges
For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels: Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals and less than 180 mg/dL (10 mmol/L) two hours after meals. However, your individual targets may differ based on your specific circumstances.
Keep Emergency Supplies Ready
Maintain a supply of ketone test strips at home and know how to use them. Keep your healthcare provider’s contact information easily accessible, including after-hours emergency numbers.
Educate Family Members
Make sure family members or close friends know the signs of diabetic emergencies and understand when to call for help. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
Document Patterns
Note when your glucose readings are above or below your target range. Keep a log of your blood sugar readings, meals, physical activity, medications, and any symptoms. This information can help your healthcare provider identify patterns and adjust your treatment plan accordingly.
Working With Your Healthcare Team
Effective diabetes management requires a collaborative approach with your healthcare team. Don’t hesitate to reach out when you have concerns about your blood sugar levels.
Regular Check-ups
Attend all scheduled appointments with your healthcare provider, endocrinologist, diabetes educator, and other specialists. These visits allow for monitoring of your overall diabetes management and early detection of potential complications.
Diabetes Self-Management Education
If you’re concerned about DKA or have questions about how to manage your diabetes, talk to your diabetes care team and ask them for a referral to diabetes self-management education and support (DSMES) for individual guidance, as DSMES services are a vital tool to help you manage and live well with diabetes while protecting your health.
Open Communication
Call your provider right away if your blood sugar readings are higher than expected, and when you call, have a list of your recent blood sugar numbers, also have a list of your insulin history including doses and times you’ve used it, and have a list of all the medicines you take.
Be honest with your healthcare team about challenges you’re facing with your diabetes management, whether related to medication costs, difficulty following dietary recommendations, or struggles with blood sugar monitoring. They can often provide solutions or alternatives you may not have considered.
Additional Resources and Support
Managing diabetes and preventing high blood sugar emergencies doesn’t have to be a solitary journey. Numerous resources are available to support you:
- American Diabetes Association: Offers comprehensive information, support groups, and educational materials at diabetes.org
- Centers for Disease Control and Prevention (CDC): Provides evidence-based diabetes information and prevention programs at cdc.gov/diabetes
- National Institute of Diabetes and Digestive and Kidney Diseases: Offers research-based information about diabetes management at niddk.nih.gov
- Local diabetes support groups: Connect with others managing diabetes in your community
- Diabetes educators and nutritionists: Provide personalized guidance on managing your condition
The Importance of Proactive Management
Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early—before it gets worse. It’s especially important to know the early signs of hyperglycemia and to monitor your blood sugar regularly if you take insulin or other medications for diabetes.
If hyperglycemia is left untreated, it can develop into diabetes-related ketoacidosis (DKA), in which a lack of insulin and a high amount of ketones cause your blood to become acidic, and DKA can also affect people who have undiagnosed Type 1 diabetes as this condition is an emergency situation that can lead to coma or death.
Final Thoughts: When in Doubt, Seek Help
When it comes to uncontrolled high blood sugar, it’s always better to err on the side of caution. Diabetic ketoacidosis is potentially life-threatening, so it’s important to get medical help right away if you are experiencing the warning signs.
If you’re unsure whether your symptoms warrant medical attention, contact your healthcare provider. They can help you determine the appropriate course of action based on your specific situation. Remember that if you have any of these symptoms, call your healthcare provider immediately or go to the nearest emergency room.
Understanding when to seek medical help for uncontrolled high blood sugar is a critical skill for anyone living with diabetes or caring for someone with the condition. By recognizing the warning signs, monitoring your blood sugar regularly, following your treatment plan, and maintaining open communication with your healthcare team, you can minimize the risk of dangerous complications and maintain better overall health.
High blood sugar emergencies are serious, but with proper knowledge, preparation, and prompt action, they can be managed effectively. Stay informed, stay vigilant, and never hesitate to seek help when you need it. Your health and safety are worth it.