Hypo and Hyper Diabetic Incidents: What You Need to Know

02 February, 2021

In 2023, the number of people living with diabetes in the UK topped five million for the first time. This increased prevalence has a financial implication for the NHS, which spends c.10% of its annual budget on diabetes treatment. It also increases the chances of members of the public and first aiders being asked to help during a diabetic incident.

Reading this blog will give you the confidence to handle such incidents, even if you’re not a fully trained first aider.

What are hypo- and hyper diabetic incidents?

A hypo is a low blood sugar diabetic emergency. A hyper is a condition caused by very high blood sugar/a severe lack of insulin.

What are the signs of a hypo?

The following are all warning signs that a diabetic’s blood sugar is too low:

Sweating
Being anxious or irritable
Feeling faint or hungry
Blurred sight
Trembling and feeling shaky

These symptoms can come on very quickly.

What can cause a hypo?

Missing a meal and exercising too much can trigger a hypo.

How should you handle a hypo if the patient is conscious?

If they are conscious, you can give them something sugary to eat or a sugary drink (such as ‘full-fat’ Coke or fruit juice). Low-calorie drinks that contain sweeteners instead of sugar won’t work! The NHS advice is to avoid sugary foods that contain fat, like chocolate or cake, as they don’t work as well. Good options include three to six dextrose or glucose sweets or a few sweets like jelly babies.

Try to remain calm and encourage bystanders to step back or disperse if you’re in a public place. Aim to help the patient stay calm and rest until their blood glucose levels have risen. The patient should check their blood glucose after ten minutes. If it’s low, they should eat something sugary again.

A first aider walked into a bar…

We promise this isn’t the start of a terrible joke! A few months ago, a Safe & Sound team member had just sat down in a pub when a man at the bar collapsed. He was able to explain that he was diabetic and needed sugar. Fortunately, she’d recently started carrying a packet of glucose tablets in her make-up bag. Within a few minutes of taking some, he’d recovered enough to explain that he’d felt ‘off’ and was checking his continuous glucose monitor. The next thing he knew, he was on the floor!

How should you handle a hypo if the patient is unconscious?

If the patient is unconscious, don’t attempt to give any food or drink. Instead:

Put them into the recovery position
Administer a glucagon injection (only if it is theirs AND you’ve been trained on how to use it)
Call for an ambulance if you can’t find an injection in their belongings, or they haven’t recovered within ten minutes of being injected

Are the symptoms of a hyper different to a hypo?

The symptoms of a hyper come on gradually and are markedly different. A patient may start showing some of the following symptoms when their blood glucose levels are too high:

Constant thirst
Blurred vision
High blood sugar
An increased need to pee
Feeling drowsy/struggling to stay awake
A distinct ‘pear drop’ smell to their breath
Confusion
Passing out

What can cause a hyper?

Stress, ill health, reduced activity, and someone not having enough insulin for the carbohydrate they have eaten can all cause a hyper.

How should you handle a hyper?

Treatment depends on the cause, and if the blood sugar is only high for a short time, emergency treatment should not be necessary.

If the casualty often has signs and symptoms of a hyper, they should see their diabetes healthcare team
If the casualty becomes unresponsive, call 999/112 immediately. Check airway and breathing. If they are not breathing normally, start CPR
If they are breathing normally, put the casualty in the recovery position and monitor the airway and breathing until help arrives
Never give an unresponsive casualty anything to eat or drink