Diabetes emergencies happen when the balance between insulin and sugar in the blood is lost. In diabetes the pancreas either makes too little insulin or the body cannot use it properly. Too much insulin, too little food or unplanned exercise can push blood sugar too low (hypoglycaemia), while missed medicine, illness or infection can push it too high (hyperglycaemia). Either extreme can cause confusion and unconsciousness, so first aiders should know how to recognise them and what to do.
Low Versus High Blood Sugar at a Glance
| Feature | Low (hypo) | High (hyper) |
|---|---|---|
| Onset | Fast, over minutes | Gradual, over hours or days |
| Skin | Cold, pale, sweaty | Warm, dry |
| Behaviour | Shaky, confused, aggressive, may seem drunk | Drowsy, thirsty, passing lots of urine |
| Breath | Normal | May smell fruity, like nail polish remover |
| Pulse | Rapid | Rapid |
Skin and breath are helpful clues but not reliable on their own.
If You Are Not Sure Which It Is
Give sugar. Low blood sugar is the more dangerous emergency in the short term and can worsen within minutes, while an extra dose of sugar in a person with high blood sugar will not cause meaningful harm in the short time before the ambulance arrives. Never give insulin to a person yourself, as an incorrect dose can be fatal.
Diabetes Emergencies First Aid: 6 Steps
- Check that the person is awake and able to swallow.
- If awake and cooperative, give about 15 to 20 grams of fast-acting sugar, such as glucose tablets, jelly beans, a sugary drink (not diet) or a few teaspoons of sugar or honey.
- Wait 10 to 15 minutes and repeat if still not better, then give a snack of longer-lasting carbohydrate.
- Call an ambulance if there is no improvement, if the person is drowsy or confused, or they cannot swallow.
- If unconscious, place them in the recovery position, give nothing by mouth, follow the DRABC primary survey and call for help.
- Stay with them until they are fully recovered and monitor with vital signs observations.
Details for each emergency follow in our articles on low blood sugar and high blood sugar.
Why Diabetes Emergencies Are Often Mistaken for Other Problems
Low blood sugar can look like intoxication, a stroke or a seizure, and high blood sugar can look like illness or exhaustion. Look for a medical alert bracelet, an insulin pen or meter, and ask relatives. Treating a person as drunk and leaving them to sleep can be fatal.
Preventing Diabetes Emergencies at Work
Employees with diabetes should be able to eat and check blood sugar on schedule and keep fast sugar available. Supervisors and first aiders should know who may need help and what their plan says. Teams doing shift work, driving or safety-critical tasks need extra planning to prevent diabetes emergencies.
Preparing a First Aid Kit for Diabetes Emergencies
Keep glucose tablets, jelly sweets or sugar sachets in the first aid kit, together with a small notepad for recording times and symptoms. Make sure the kit is checked regularly, that sweets are in date, and that everyone knows where it is. A written plan for each known person with diabetes, listing their medicines, usual symptoms and emergency contacts, helps first aiders act quickly and confidently in diabetes emergencies.
Frequently Asked Questions
Can a first aider give insulin?
No. Never give insulin unless you are the person’s trained carer following their plan. Always seek medical help.
Is it safe to give sugar to someone with high blood sugar?
A short-term sugar dose is unlikely to cause harm and is the safer choice when you cannot tell which type of emergency it is.
References and Further Reading
- NHS, Diabetes
- NHS, Low blood sugar (hypoglycaemia)
- American Heart Association and American Red Cross, Guidelines for First Aid
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
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