CHAPTER 30 — WARNING SIGNS, EMERGENCIES & WHEN TO SEEK HELP This chapter explains which symptoms need urgent medical help, which signs should never be ignored, and how to prepare so that you and your family know what to do. It is general education only and does not replace local emergency services or personal medical advice. IMPORTANT NOTE If you ever feel that something is seriously wrong:
- Trust your instincts.
- Contact emergency services or local urgent care immediately.
- It is always better to be checked and told it is safe than to wait too long.
SECTION 1 — LOW BLOOD SUGAR (HYPOGLYCAEMIA) Low blood sugar happens mainly in people who use:
- Insulin
- Sulfonylureas (certain tablets that stimulate insulin release)
- Other medicines that can cause hypoglycaemia
COMMON SYMPTOMS OF LOW BLOOD SUGAR Mild to moderate:
- Shaking or trembling
- Sweating
- Sudden hunger
- Fast heartbeat
- Feeling anxious or irritable
- Tingling around lips or fingers
- Weakness or lightheadedness
More severe:
- Confusion
- Difficulty speaking clearly
- Blurred vision
- Behaviour changes or unusual aggression
- Loss of coordination
- Drowsiness or inability to stay awake
If untreated:
- Seizure
- Loss of consciousness
BASIC LOW BLOOD SUGAR ACTION PLAN (FOR PEOPLE AT RISK) If you are awake and able to swallow safely: 1. Check your glucose if possible. 2. Take fast acting carbohydrate as advised by your healthcare team. This is often something like:
- Glucose tablets
- Glucose gel
- Sugary drink in a measured amount
3. Recheck glucose after about 15 minutes. 4. If still low, repeat fast acting carbohydrate. 5. Once glucose has improved, eat a small snack that contains carbohydrate and some protein, if your plan recommends this. If you are taking medicines that do not cause low blood sugar and you are not at risk, this section may not apply, but it is still good to understand the signs. EMERGENCY FOR LOW BLOOD SUGAR Call emergency services immediately if:
- The person is unconscious or having a seizure.
- The person cannot swallow safely.
- Low blood sugar does not improve with treatment.
- You do not know how to treat it safely.
Family members and close contacts should know:
- Where glucose tablets or gel are kept.
- Local emergency numbers.
- How your doctor advises you to treat low blood sugar.
SECTION 2 — VERY HIGH BLOOD SUGAR AND SERIOUS ILLNESS Very high glucose, especially with illness, dehydration, or infection, can become dangerous. WARNING SIGNS WITH HIGH GLUCOSE
- Very high meter or CGM readings that stay high.
- Extreme thirst.
- Frequent urination.
- Dry mouth and dry skin.
- Blurred vision.
- Nausea or vomiting.
- Stomach pain.
- Deep or fast breathing.
- Fruity or unusual smell on the breath.
- Extreme tiredness or confusion.
These may be signs of serious conditions such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), which need urgent hospital treatment. EMERGENCY ACTION FOR VERY HIGH GLUCOSE WITH SICKNESS Contact emergency services or urgent medical help immediately if:
- You are vomiting and cannot keep fluids down.
- You have difficulty breathing.
- You feel very drowsy, confused, or unable to stay awake.
- You have chest pain.
- You have severe abdominal pain.
- Your glucose is very high and does not improve, especially during illness.
Do not wait for symptoms to improve on their own if they are severe. SECTION 3 — HEART, BRAIN, AND CIRCULATION WARNING SIGNS People with Type 2 Diabetes have increased risk of heart attack and stroke. Fast action saves heart muscle and brain cells. POSSIBLE HEART ATTACK SIGNS
- Chest pain, pressure, tightness, or burning, which may:
- Spread to the arm, neck, jaw, or back.
- Last more than a few minutes or come and go.
- Unusual shortness of breath.
- Sudden cold sweat.
- Nausea or vomiting.
- Unusual tiredness or weakness.
- In some people, especially women and older adults, symptoms may be subtle, such as:
- Jaw pain
- Upper back discomfort
- Indigestion type feeling with breathlessness
POSSIBLE STROKE SIGNS Use a simple checklist:
- Face: one side of the face droops or feels numb.
- Arm: weakness or numbness in one arm or leg, especially on one side.
- Speech: difficulty speaking, slurred speech, or difficulty understanding.
- Time: call emergency services immediately. Do not wait.
Other stroke signs:
- Sudden severe headache.
- Sudden loss of balance or coordination.
- Sudden vision loss or double vision.
Any of these signs require urgent emergency assessment, even if they improve after a few minutes. SECTION 4 — FOOT, SKIN, AND INFECTION EMERGENCIES Feet and skin need daily attention. Some changes are urgent. URGENT FOOT OR SKIN SIGNS Seek urgent medical help if:
- There is an open wound on the foot that is deep, spreading, or not healing.
- The foot or leg becomes red, hot, and swollen.
- There is pus or a bad smell from a wound.
- Skin turns black, blue, or very dark in an area.
- There is sudden strong pain in a foot that previously had reduced sensation.
- You have fever with any foot wound.
These can be signs of serious infection or poor blood flow. GENERAL INFECTION WARNING SIGNS People with Type 2 Diabetes can become more unwell from infections. Seek urgent care if:
- Fever is high or lasts more than a couple of days.
- You feel very weak or confused.
- Breathing becomes difficult.
- There is chest pain when breathing.
- You cannot drink enough to stay hydrated.
- Your glucose is much higher than usual and not improving.
SECTION 5 — VISION AND EYE EMERGENCIES Contact an eye specialist or urgent care immediately if:
- There is sudden loss of vision in one or both eyes.
- There are many new dark floaters or flashes of light.
- There is a curtain or shadow over part of your vision.
- There is eye pain with redness and blurred vision.
These can be signs of retinal detachment, bleeding inside the eye, or other urgent problems. SECTION 6 — WHEN TO CONTACT YOUR REGULAR HEALTHCARE TEAM (NON-EMERGENCY) You should contact your usual doctor or diabetes nurse promptly (but it is not an emergency) if:
- Your glucose is consistently higher than agreed targets over several days.
- You notice new numbness, tingling, or burning in feet or hands.
- You have new swelling in legs or ankles.
- You have changes in vision that are gradual rather than sudden.
- You are losing weight without trying.
- You have increasing thirst and urination for several weeks.
- You feel emotionally overwhelmed, depressed, or unable to manage daily self care.
These signs mean that your plan may need adjustment, but they usually do not require an ambulance. Your team can advise on the next steps. SECTION 7 — PREPARING A SIMPLE PERSONAL EMERGENCY PLAN A short plan can make emergencies less chaotic. Consider preparing: 1. A written list that includes:
- Your diagnosis (Type 2 Diabetes) and any other major conditions.
- All medications and doses.
- Any known allergies.
- Contact details for your main doctor or clinic.
- Emergency contact person such as family or friend.
2. Where to keep it:
- In your wallet or purse.
- On your phone.
- At home in a visible place.
3. Information for family or close friends:
- How you usually treat low blood sugar if you are at risk.
- Where your glucose tablets or gel are kept.
- Which local number to call for emergencies.
- Any specific instructions from your doctor.
SECTION 8 — MENTAL HEALTH CRISES Mental health emergencies are as serious as physical ones. Seek urgent help if:
- You feel that life is not worth living.
- You have thoughts of harming yourself.
- You feel unable to control actions that could harm yourself or others.
Contact:
- Local emergency services.
- A crisis line or hotline if available in your country.
- A trusted family member or friend and ask them to stay with you while you seek help.
SECTION 9 — KEY MESSAGES
- Type 2 Diabetes is manageable, but some situations require urgent attention.
- Low blood sugar, very high blood sugar with sickness, heart and stroke symptoms, serious foot or eye changes, and severe infections are never to be ignored.
- When in doubt, it is safer to seek urgent help than to wait.
- A simple emergency plan and basic knowledge shared with family can save time and reduce panic.
- Good daily management reduces the chance of emergencies, but knowing what to do remains essential.
This chapter completes the main safety foundation for Type 2 Diabetes, helping you and those around you recognise danger signs early and respond quickly.