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Diabetes: low sugar, high sugar and coma

In a person with diabetes two opposite states look alike — shaking, confusion, strange behaviour — but need opposite treatment. Low sugar kills within minutes, high sugar within hours. So the first action is always the same: measure. If there is no meter and the person can swallow, give something sweet: it saves a hypo and does no harm in a hyper.

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What to do right now

Measure the blood sugar
Below 3.9 mmol/l is hypoglycaemia. Above 15 with the smell of acetone, vomiting and rapid breathing is ketoacidosis.
Low sugar, conscious
15 grams of fast carbohydrate: 3–4 sugar cubes, half a glass of juice or regular soft drink, honey. Re-measure after 15 minutes, then eat a sandwich.
Low sugar, unconscious
Nothing by mouth. Turn on the side and call. If a glucagon pen is available, inject into the thigh.
High sugar
Drink water, no carbohydrates, correction insulin if the regimen is known. With vomiting, abdominal pain or acetone — call a crew.
Look for the cause
A missed meal, an extra dose, alcohol or exercise for a hypo; a missed insulin dose, infection or fever for a hyper.

Call an ambulance if

Unconscious, seizures, unable to take anything sweet
Sugar does not rise above 4 after two portions of carbohydrate
Sugar above 15–20 with vomiting, the smell of acetone, deep rapid breathing, abdominal pain
Confusion, drowsiness or odd behaviour in a person with diabetes
Hypoglycaemia on sulfonylurea tablets — it can recur for a day
A diabetic with fever and vomiting who cannot eat or drink

What not to do

Do not pour sweet drinks into an unconscious person — they will choke
Do not inject insulin into a confused person without measuring the sugar
Do not give chocolate for hypoglycaemia — fat slows absorption
Do not leave the person alone for a day after an episode if they take diabetes tablets

What the crew does

Blood glucose, consciousness, blood pressure, ECG
Intravenous glucose for hypoglycaemia; fluids and correction for ketoacidosis
Observation until stable and a review of the cause
Admission for coma, ketoacidosis or hypoglycaemia that does not respond

This page is for information and does not replace a medical examination. If the condition worsens, call the crew: +7 (985) 887-82-52.

This page in Russian: Russian version.

Questions

A diabetic is behaving as if drunk — what is it?

Classic hypoglycaemia. Measure the sugar and give something sweet if they can swallow. The smell of alcohol does not rule it out: drinking actually provokes low sugar.

How much does a call-out to a diabetic cost in Moscow?

Call-out 6,000 ₽ inside the MKAD, glucose testing by the price list, intravenous glucose or an infusion by the list.

An elderly parent with diabetes lives alone — how do we make it safer?

A glucose meter and juice in plain sight, calls morning and evening, a medical bracelet with a phone number. If they sound confused on the phone, do not wait — call.