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Diabetes: Short Term Problems


Diabetes can cause other health problems. Sometimes these problems are referred to as complications (COM-pli-KAY-shuns). Short-term problems can happen at any time when you have diabetes. Long-term problems may develop when you have diabetes for a long time.

In case of emergency, you should always wear a form of medical identification (ID). Examples are ID bracelets and necklaces. To reduce your risk of getting other health problems from diabetes, you need good control of your blood glucose (sugar). Good control means keeping blood glucose at certain levels. To learn more about good control and healthy blood glucose numbers, see the UPMC patient education page Diabetes: Your Management Plan.

This patient education sheet tells you about short-term problems, what to do for them, and how to prevent them:

  • Low blood glucose
  • High blood glucose with ketones
  • High blood glucose without ketones

Low Blood Glucose

Low blood glucose is also called hypoglycemia (HI-po-glice-EE-me-uh). Blood glucose numbers under 70 mean you have low blood glucose. Several things can cause low blood glucose:
  • Too much insulin
  • Too much sulfonylurea (SULL-fon-ilyour-EE-uh) medicine
  • Not enough food
  • Too much exercise

Symptoms of low blood glucose include:

  • Hunger
  • Feeling nervous
  • Heavy sweating
  • Weakness
  • Shaking (tremors)
  • Confusion
  • Seizures
  • Coma

If you get low blood glucose

If you get low blood glucose and you are awake and able to swallow, eat or drink something with sugar. Here is a list of some suggested foods:
  • 4 ounces of fruit juice
  • 4 to 6 ounces of sugary (non-diet) soft drink
  • 3 to 4 glucose tablets (or 1 tube of glucose gel)
  • 1 cup of skim milk
  • 6 to 7 hard candies (not sugar-free), such as Lifesavers

Wait for 10 to 15 minutes. Test your blood glucose again.

  • If your blood glucose is above 70 and you feel better, you can go back to what you were doing. If your next meal is more than 30 minutes away, you should eat an extra snack. For example, you can eat half of a peanut butter or meat sandwich and drink a glass of milk.
  • If your blood sugar is still under 70, eat or drink another serving of your snack. After 15 minutes, test your blood glucose again. If you still have low blood glucose after 3 tests, call your doctor.
  • If your blood glucose goes too low, you can become confused and unable to eat or drink safely. If you are not awake, or if you are not able to eat or drink something that contains sugar, you will need help. Another person can assist by rubbing sugar or something sweet along your gums. Examples are jelly, jam, pancake syrup, and cake icing. Get emergency care right away if you don’t begin to respond, or if blood glucose remains under 70.

A family member or friend can learn to give you an injection (shot) of glucagon (GLOOka-gon). Glucagon is a hormone that helps the liver release sugar into your blood. Ask your doctor about glucagon.

High Blood Glucose

High blood sugar is also called hyperglycemia (HI-per-glice-EE-me-uh). Symptoms of high blood glucose include:

  • Feeling tired
  • Blurred vision
  • Increased thirst
  • Increased hunger
  • Passing urine often

You can have high blood glucose with few symptoms or no symptoms at all. Testing your blood glucose is often the only sure way to detect high blood glucose. High blood glucose over a long time damages the blood vessels, nerves, and other organs like the eyes, kidneys, and heart. See the UPMC patient education sheet Diabetes: Long-Term Problems.

Two short-term problems related to high blood glucose are very serious. One problem is high blood glucose levels with ketones in the blood and urine. The other is high blood glucose levels, but without ketones.

High Blood Glucose with Ketones

DKA is the short name for diabetic ketoacidosis (KEE-toh-ASS-ih-DOE-sis). DKA is a serious problem. Usually only people with Type 1 diabetes get DKA. It occurs when the body does not have enough insulin to change sugar into energy. Blood glucose is the body’s main fuel.When there is not enough insulin, sugar stays in the blood and cannot be used for fuel. Since the body still needs fuel for energy, it must then use body fat for fuel When the body burns fat, it forms waste products called ketones (KEE-tones). Ketones build up in the blood and come out in the urine. Ketones can make you very sick.

Symptoms of DKA

DKA can happen quickly if you are sick or have severe stress. If you have any of these symptoms, call your doctor right away. Symptoms of high blood glucose and DKA are:

  • Increased thirst
  • Increased hunger
  • Passing urine often
  • Feeling very tired
  • Blurred vision
  • Sweet or fruity smell on your breath
  • Stomach pain
  • Nausea or vomiting
  • Rapid or deep breathing
  • Excessive loss of water (dehydration)
  • Ketones in your urine

Checking for ketones

If you have Type 1 diabetes, you need to learn to check your urine for ketones. Ask your doctor or diabetes educator how to do the test. You should check your urine for ketones several times a day when you have:

  • Blood sugar over 240
  • Fever, cold, flu, or any infection
  • A sick feeling
  • Severe stress
  • Vomiting or nausea
  • Symptoms of high blood sugar or DKA

When you have ketones

When you have ketones in your urine, do not exercise. If you have moderate ketones (2+) or large ketones (3+), call your doctor.

If your blood glucose level is over 240 and you have ketones in your urine, call your doctor right away. Do not try to treat this problem yourself. Check with your doctor about what you should do. You will need to check your blood glucose often. You also will need to drink plenty of water and sugar-free fluids. You may also need to take more insulin to treat DKA.

To avoid DKA

It is very important that you take these steps:

  • Follow your insulin routine exactly.
  • Take the right amount of insulin, and take it on time every day.
  • Never skip your dose of insulin, even if you are sick. Check with your doctor first.
  • Test your blood glucose regularly and keep a written record.

High Blood Glucose without Ketones

HHNS is a serious condition of high blood glucose. HHNS is short for hyperglycemic (HI-per-glice-EE-mik) hyperosmolar (HIper-oz-MOL-er) non-ketotic (non-kee-TOTik) syndrome (SIN-drome). Usually HHNS occurs only in people with Type 2 diabetes.

In some ways, HHNS is like DKA in people with Type 1 diabetes. The difference is that people with Type 2 diabetes rarely get ketones in their blood. If you have Type 2 diabetes, your pancreas still makes some insulin. Even a small amount of insulin can change sugar into energy. Your body uses the sugar first before it has to break down fat for fuel. So ketones are rarely produced.

HHNS has very few early symptoms. Blood glucose levels may be dangerously high for a long period of time. You have a greater chance of getting other health problems from diabetes.

Symptoms of HHNS

Usually HHNS happens more slowly than DKA. But when you are sick or severely stressed, HHNS can occur more easily.

Symptoms are like those of high blood glucose:

  • Feeling tired
  • Blurred vision
  • Extreme thirst
  • Increased hunger
  • Passing urine often

If you have any of these symptoms, call your doctor. If your blood glucose is over 350, call your doctor. You will need to check your blood glucose often, at least every 4 hours. Drink plenty of water and sugar-free fluids. When your blood glucose is extremely high, do not exercise. For a safe blood glucose range before you exercise again, call your doctor.

To avoid HHNS

It is very important that you take these steps:

  • Follow your medication routine exactly.
  • Take the right amount of medicine and take it on time every day.
  • Never skip your dose of medication, even if you are sick. Check with your doctor first.
  • Test your blood glucose regularly and keep a written record.


When you get sick, do the following:

  • Check your blood glucose more often, at least every 4 hours.
  • Take your diabetes medicine as usual, unless your doctor tells you otherwise.
  • Drink lots of fluids.
  • Get plenty of rest.
  • Check your temperature. If you have a temperature of 101.5 degrees Fahrenheit or higher, call your doctor.
  • Check your urine for ketones if you have Type 1 diabetes. If you have ketones, call your doctor.


If you can eat regular meals, also drink ½ cup of sugar-free fluid every hour while awake.

For example:

  • Broth or bouillon
  • Unsweetened tea, or with artificial sweetener
  • Sugar-free soda
  • Water

If you cannot eat your regular meals, try to drink fluids every hour that you are awake. Choose fluids that have 15 grams of carbohydrates. For example:

  • 1/2 cup fruit juice
  • 3/4 cup ginger ale (not diet)
  • 1/2 cup regular soda (not diet)
  • 1 1/2 cup chicken noodle soup
  • 1 1/2 cup chilled Gatorade
  • 1/4 cup sherbet
  • 1/2 cup regular jello (not sugar free)

When to call the doctor

If you have any of the following, call your doctor:

  • Vomiting or diarrhea for 6 hours or more
  • Fever, nausea, or feeling “bad” for 24 hours
  • Blood glucose of 240 or higher when you are sick
  • Moderate ketones (2+) or large ketones (3+) in your urine
  • Temperature of 101.5 degrees Fahrenheit or higher
  • You are not sure what to do

Your doctor may work out a sick-day insulin scale for you. Your dietitian can work out a sick-day meal plan for you. If your blood glucose numbers are too high or too low, do not adjust your dose of medicine until you check with your doctor.

                                                                                                                          Reviewed July 2013

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