When to Seek Medical Care
If you someone you know are not known to have diabetes but are having any
symptoms that suggest diabetes or concern you in any way, make an appointment to
see a healthcare provider as soon as possible. When you make the appointment,
tell the operator that you are concerned about diabetes. He or she may make
arrangements for blood sugar testing before the appointment.
If the patient is known to have diabetes, call a healthcare provider right
away if any of the following apply:
When you call a healthcare provider, tell the operator that you or someone you
know has diabetes and are concerned.
- The patient is experiencing diabetes symptoms. This may mean that your
blood sugar level is not being controlled despite treatment.
- The patient's blood sugar levels, when tested, are consistently high (more
than 200 mg/dL). Persistently high blood sugar levels are the root cause of
all of the complications of diabetes.
- The patient's blood sugar level is often low (less than 60
may mean that management strategy is too aggressive. It also may be a sign
of infection or other stress on the system such as kidney failure, liver
failure, adrenal gland failure, or the concomitant use of certain
- The patient has an injury to the foot or leg, no matter how minor. Even
the tiniest cut or blister can become very serious in a person with
diabetes. Early diagnosis and treatment of problems with the feet and lower
extremities, along with regular diabetic
foot care, are critical in preserving the function of the legs and
- The patient has a low-grade fever (less than 101.5°F). Fever
is a sign of infection. In patients with diabetes, many common
infections can potentially be more dangerous for them than for other people.
Note any symptoms, such as painful urination, redness or swelling of the
pain, or cough, that may indicate where the infection is located.
- The patient is nauseated or vomiting but can keep liquids down. The
healthcare provider may adjust medications while the patient is sick and
will probably recommend an urgent office visit or a visit to the emergency
department. Persistent nausea and vomiting can be a sign of diabetic
ketoacidosis, a potentially life-threatening condition, as well as several
other serious illnesses.
- The patient has a small sore (ulcer) on the foot or leg. Any non-healing
sore or ulcer on the feet or legs of someone with diabetes needs to be seen
by a medical professional right away. A sore less than 1 inch across, not
draining pus, and not exposing deep tissue or bone can safely be evaluated
in a healthcare provider's office as long as the patient does not have fever
and their blood sugar levels are in control.
- The patient will probably be referred to a nurse who will ask questions
and make a recommendation about what to do.
- Be prepared for this conversation. Have a list of medications, medical
problems, allergies to medicines, and a blood sugar diary handy by the
- The nurse may need any or all of this information to decide both the
urgency of the patient's condition and how best to recommend treatment for
The following situations can become 911 medical emergencies and warrant an
immediate visit to a hospital emergency department.
- The person with a severe diabetic complication may travel to the emergency
department by car or ambulance.
- A companion should go along to speak for the person if the person is not
able to speak for himself or herself with the emergency care provider.
- Bring a list of medical problems, medications, allergies to medications,
and the blood sugar diary to the emergency department. This information will
help the emergency care provider diagnose the problem and treat it
The following are signs and symptoms of diabetic complications that warrant
- Altered mental status: Lethargy, agitation, forgetfulness, or just
strange behavior can be a sign of very low or very high blood sugar levels.
- If the person is a known diabetic, try giving him or her some fruit
juice (about 6 ounces) or cake icing if the person is awake enough to
swallow normally without choking.
Avoid giving things such as hard candy that can lodge in the throat. The
healthcare provider can prescribe glucose wafers or gels that melt under
- If the person does not wake up and behave normally within about 15
minutes, call 911.
- If the person is not a known diabetic, these symptoms can be signs of
stroke, drug intoxication, alcohol
intoxication, oxygen starvation, and other serious medical
conditions. Call 911 immediately.
- Nausea or vomiting: If the patient is known to have diabetes and
cannot keep food, medications, or fluids down at all, they may have diabetic
ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another
complication of diabetes.
- If the patient has not already taken the latest insulin dose or oral
diabetes medicine, do not take it without talking to a medical
- If the patient already has low
blood sugar levels, taking additional insulin or medication will
drive the blood sugar level down even further, possibly to dangerous
- Fever of more than 101.5°F: If the primary healthcare provider
cannot see the patient right away, seek emergency care for a high fever if
they are diabetic. Note any other symptoms such as cough, painful urination,
abdominal pain, or chest
- High blood sugar level: If the patient's blood sugar level is more
than 400 mg/dL, and the primary healthcare provider cannot see them right
away. Very high blood sugar levels can be a sign of diabetic ketoacidosis or
hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of
diabetes you have. Both of these conditions can be fatal if not treated
- Large sores or ulcers on the feet or legs: If the patient has
diabetes, a non-healing sore larger than 1 inch in diameter can be a sign of
a potentially limb-threatening infection.
- Other signs and symptoms that merit immediate care are exposed bone or
deep tissue in the wound, large areas of surrounding redness and warmth,
swelling, and severe pain in the foot or leg.
- If left untreated, such a sore may ultimately require amputation of
or lacerations: Any cut penetrating all the layers of skin,
especially on the legs, is a potential danger to a person with diabetes.
care, although important to anyone's recovery, is especially important
in diabetics to assure good wound healing.
- Chest pain: If the patient is diabetic, take very seriously any
pain in the chest, particularly in the middle or on the left side, and seek
medical attention immediately.
- People with diabetes are more likely than non-diabetic people to have
attack, with or without experiencing chest pain.
- Irregular heartbeats and unexplained shortness of breath may also be
signs of heart attack.
- Severe abdominal pain: Depending on the location, this can be a
sign of heart attack, abdominal aortic
aneurysm (widening of the large artery in the abdomen), diabetic
ketoacidosis, or interrupted blood flow to the bowels.
- All of these are more common in people with diabetes than in the
general population and are potentially life-threatening.
- Those with diabetes also get other common causes of severe abdominal
pain such as appendicitis,
perforated ulcer, inflammation and infection of the gallbladder,
stones, and bowel obstruction.