Diabetic Emergency First Aid: How to Spot a Hypo and What to Do

Around 1.3 million Australians live with diabetes, so this is an emergency you are statistically likely to witness at some point — and it is one of the few where a bystander with a packet of jellybeans genuinely fixes the problem.

It is also the emergency most often mistaken for something else. A person having a hypo can be confused, slurring, unsteady and behaving strangely. That looks a great deal like being drunk, and people get left to sleep it off.

Hypoglycaemia: the signs of a low

In Australia, a blood glucose level below 4 mmol/L is a hypo. The phrase worth remembering is “four is the floor”.

Early signs

• Shaking or trembling, and sweating
• Pale skin and a faster heartbeat
• Weakness, dizziness or light-headedness
• Sudden hunger
• Tingling in the lips, tongue or cheeks
• Anxiety, agitation or irritability — sometimes out of character
• Headache, nausea, or blurred vision

Signs it is becoming severe

• Confusion and slurred speech
• Behaving strangely, or being unusually aggressive
• Drowsiness
• Seizure
• Loss of consciousness

Hypos are usually caused by a mismatch: too much insulin, more activity than usual, a missed or delayed meal, not enough carbohydrate, alcohol, or vomiting and diarrhoea.

What to do if they are awake and can swallow

1. Make them safe first. Stop the car, stop the machinery, get them off the ladder, sit them down.
2. Give 15–20 g of fast-acting glucose. Australian guidance names 4 to 5 glucose tablets (4 g each) as the first choice. If you do not have those, any of these work:
   • 6 to 7 jellybeans
   • Half a can of full-strength soft drink — not diet or zero-sugar
   • Half a glass of fruit juice (about 150–200 mL)
   • 3 teaspoons of sugar or honey
   • Glucose gel, or lollies such as Mentos or Skittles
3. Wait 15 minutes. Re-check their blood glucose if a meter is available.
4. Still under 4, or still unwell? Repeat the fast-acting glucose.
5. Once they have recovered, give something longer-acting — a sandwich, a glass of milk, a piece of fruit, or yoghurt. This is the step people skip, and skipping it is why hypos come back.
6. Stay with them until they are properly back to themselves.

What to do if they are unconscious or having a seizure

This is a severe hypo and it is a Triple Zero call.

1. Give nothing by mouth. No food, no drink, no gel, and do not put your fingers in their mouth. They cannot swallow safely and it can go into the lungs.
2. Roll them onto their side into the recovery position and make sure the airway is open and clear.
3. Call Triple Zero (000) and say you think it is a diabetic emergency.
4. If glucagon is available and you know how to use it, give it. See below.
5. If they are not breathing normally, start CPR and follow DRSABCD.
6. If they are having a seizure, protect their head and do not restrain them — see seizure first aid.

About glucagon

Glucagon is an injection that raises blood glucose, and many people with type 1 diabetes carry one. Australian guidance says to use it for a severe hypo when the person is unconscious, having a seizure, or unable to swallow safely — if you are trained to do so. The doses given are:

• Adults and children over 25 kg: 1 mg (1 mL)
• Children under 25 kg: 0.5 mg (0.5 mL)

It works less well if the person has not eaten for more than 12 hours, or has advanced liver disease. Glucagon is not a substitute for the ambulance — call 000 either way.

Hyperglycaemia: the signs of a high

Highs come on far more slowly than lows — over hours or days rather than minutes — but they can still become an emergency.

• Excessive thirst and frequent urination
• Dry skin and mouth
• Fatigue and weight loss
• Rapid pulse
• Nausea, vomiting or abdominal pain
• Rapid, deep breathing
• Breath that smells sweet or fruity
• Confusion, drowsiness or unresponsiveness

The last four together are the worrying combination — deep breathing, fruity breath, vomiting and confusion suggest a serious complication and need an ambulance.

Telling a hypo from other emergencies

When to call an ambulance

Call Triple Zero (000) if the person:

• Becomes unconscious or cannot be roused
• Has a seizure
• Is deteriorating
• Has not improved after 10 to 15 minutes of treatment
• Cannot swallow safely, or is vomiting
• Has hypos repeatedly, or one with no explanation
• Shows the high-glucose warning combination — deep breathing, fruity breath, vomiting, confusion

If you or someone you care for has diabetes

• Carry hypo treatment and keep it accessible — not in the boot, not at the bottom of a bag. Glucose tablets or jellybeans in a pocket.
• Keep spares where you spend time: car, desk, gym bag, bedside.
• Tell the people around you what a hypo looks like in you specifically, and where your treatment lives.
• Check whether your glucagon has expired, and make sure someone in the household knows how to use it.
• Wear or carry a medical ID. The point of failure in a severe hypo is that you cannot explain yourself.
• See also why online medical records matter with a chronic condition and tips to manage your medication safely.

Related reading: what to say when you call an ambulance and the full DRSABCD action plan. If you take insulin, that is exactly the kind of detail a paramedic needs before you can tell them — you can create your emergency profile in a few minutes.

Diabetic emergency FAQs

Sources

• ANZCOR Guideline 9.2.9 — First aid management of a diabetic emergency — recognition of highs and lows, 15–20 g glucose, nothing by mouth when unconscious, positioning, glucagon doses, when to call an ambulance, and treating as hypoglycaemia when unsure.
• healthdirect — Hypoglycaemia — the 4 mmol/L threshold, early and severe symptoms, causes, and treatment quantities.
• Diabetes Australia — Hypoglycaemia and hyperglycaemia — quick-acting glucose options and the 15-minute re-check.
• National Diabetes Services Scheme — Hypoglycaemia — hypo kit and management.
• Triple Zero (000) — when and how to call.

Disclaimer: This article is general first aid information, not medical advice or a substitute for accredited first aid training. In an emergency, always call Triple Zero (000). Diabetes management is individual — follow the plan your own diabetes team has given you, and never start, stop or change insulin or any other medication on the basis of a web page. For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland) or speak with your GP. MedibandPlus stores and provides access to a member’s own medical information; it does not assess, diagnose or treat any condition.

More first aid guides

• Signs of stroke and the FAST test
• Seizure first aid
• The recovery position, step by step
• How to do CPR: a beginner’s guide
• DRSABCD: the first aid action plan explained
• Fainting first aid
• Calling an ambulance in Australia