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Diabetic emergencies (hypoglycaemia)
What is diabetic emergency (hypo)?
Hypoglycaemia happens when blood glucose falls below the normal range, often because of too much insulin or other diabetes medication, missed meals, unplanned exercise or alcohol, and can develop quickly. Symptoms include sweating, shakiness, hunger, palpitations, irritability and difficulty concentrating, which can progress to confusion, drowsiness, seizures or unconsciousness if not treated.
Prompt treatment with fast-acting carbohydrate, such as glucose tablets, sugary drinks or glucose gel in line with an agreed hypo protocol, usually reverses symptoms within minutes, but delayed or inadequate treatment increases the risk of injury, aspiration and hospital admission. First aiders should recognise that people with diabetes may not always be aware of their symptoms, particularly if they have had frequent hypos, and that behaviour changes or aggression can reflect low blood sugar rather than deliberate misconduct.
Hypoglycaemia (low blood sugar) is a common complication of diabetes treatment, and severe episodes can cause seizures, loss of consciousness and, rarely, death if not recognised and treated promptly.
Who needs this skill?
Health & Social Care
In health and social care, staff should follow local hypo protocols and use hypo boxes with agreed treatments such as glucose gel, juice or intravenous glucose for adults who can swallow safely, escalating to 999 or urgent medical review when hypos are severe, recurrent or not responding. Community and care home staff must also consider safeguarding and capacity when repeated episodes occur or when people cannot manage their own diabetes safely.Licensed venues & nightlife
In nightlife and licensed venues, low blood sugar may be mistaken for intoxication; staff should be alert to medical bracelets, testing kits or insulin pens and consider hypoglycaemia in anyone with diabetes who becomes confused, aggressive or drowsy, calling 999 if in doubt rather than ejecting them.Schools
Many pupils and staff manage diabetes at school, and hypos are a predictable risk; schools that understand hypo boxes, care plans and when to call 999 are better placed to keep people safe without overreacting to every episode.Workplaces
In workplaces, first aiders may encounter colleagues or visitors with diabetes who become pale, sweaty, confused or uncooperative; they should think 'could this be a hypo?', check for medical ID, offer sugary drinks if the person is conscious and able to swallow, and call 999 if there is no rapid improvement. Employers should ensure first aid arrangements account for staff with diabetes, especially in safety-critical roles.How to manage diabetic emergency (hypo)
- 1Recognise possible hypoglycaemiaLook for sweating, tremor, paleness, hunger, anxiety, confusion, strange behaviour, difficulty speaking or fitting in a person known or suspected to have diabetes, and consider a hypo whenever behaviour is out of character.If glucose monitoring is available and within your role, a low reading supports the diagnosis, but you should not delay treatment while searching for a meter if clinical suspicion is high.
- 2Give fast-acting carbohydrate if they are awake and can swallowIf the person is conscious, cooperative and able to swallow safely, offer 15-20 g of fast-acting carbohydrate such as glucose tablets, sugary drinks or glucose gel squeezed into the side of the mouth, as per their care plan or local guidance.Avoid giving food or drink to anyone who is drowsy, confused or unable to sit upright, because of the risk of choking; in these cases follow local protocols and call 999.
- 3Recheck and repeat treatment if neededIf symptoms improve within 10-15 minutes, encourage a longer-acting carbohydrate snack if appropriate, such as a sandwich or biscuits, to help prevent recurrence.If there is little or no improvement after the initial treatment, repeat fast-acting carbohydrate once if safe to do so and seek urgent medical advice.
- 4Call 999 if the person is unconscious, fitting or not improvingIf the person has a seizure, is unconscious, cannot swallow, or fails to improve quickly despite treatment, call 999 immediately and follow the call-handler's instructions.Place unconscious casualties who are breathing normally in the recovery position, protect their airway and do not put anything in their mouth.
- 5Monitor, document and hand overStay with the person, monitor breathing and level of consciousness and gather information about their diabetes, usual medications, recent food intake and any previous hypos to pass on to ambulance crews or clinicians.Record the episode according to local policy, including timing, treatments given and response, as repeated hypos may require diabetes review.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about diabetic emergency (hypo) training.
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Behaviour changes and aggression can be features of hypoglycaemia; try to stay calm, explain that you are concerned about low blood sugar and involve trusted family, carers or colleagues where possible. If you believe they lack capacity and are at serious risk, follow local guidance on acting in best interests and consider calling 999 or the police if safety is compromised.
Health and social care providers should maintain stocked hypo boxes and clear protocols, and ensure staff are trained to recognise and treat hypos promptly. Workplaces and venues should encourage staff with diabetes to share action plans if they wish, and build ‘think hypo’ prompts into deterioration training and incident reviews.