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Hypoglycemia, DKA, and HHS

Recognize the distinct mechanisms and urgent warning signs of major glucose-related emergencies.

2 min readEasy read2 sourcesChecked 30 Sept 2026Established

By The Diabetes Guide editorial project · Updated 30 Sept 2026

On this page
In simple words

Three emergencies matter: low sugar (hypoglycemia), DKA (too many ketones, acid) and HHS (very high sugar with severe dehydration).

  1. Step 1: Low sugar

    Shaking, sweating, hunger and a pounding heart can turn into confusion or fainting. Someone who cannot swallow safely needs emergency help.

    For example: A phone at 1% battery: it can suddenly switch off.

  2. Step 2: DKA

    Without enough insulin, the body burns fat and makes acid ketones. It needs hospital care.

    For example: A car burning the wrong fuel produces a lot of smoke.

  3. Step 3: HHS

    Very high sugar and severe dehydration. The person may be confused.

    For example: A sponge left in the sun, dried out and hard.

Remember: When someone is confused or unwell, get emergency help first.

The full story

Want more? Below is the detailed version with the real science words. It is fine to skip it.

Hypoglycemia: insufficient circulating glucose

Low glucose can follow insulin or some glucose-lowering medicines, missed food, activity or other illness. Sweating, shaking, hunger and palpitations can progress to confusion, seizures or unconsciousness. Severe hypoglycemia is defined by the need for help, not merely one cutoff. Someone unable to swallow safely should not receive food or drink by mouth; use their prescribed rescue plan and emergency help. 1

DKA: ketones, acidosis, and dehydration

Insulin deficiency permits excessive lipolysis, meaning fat breakdown, and liver ketone production. Acidosis affects cell and organ function. Urinary fluid losses and electrolyte shifts further threaten circulation and heart rhythm. DKA often occurs in Type 1 but can occur in other forms of diabetes, including with some SGLT2-related presentations that do not have very high glucose. 2

HHS: profound hyperosmolar dehydration

Hyperosmolar hyperglycemic state usually involves very high glucose and severe dehydration with less prominent ketoacidosis. Hyperosmolar means blood has an abnormally high concentration of dissolved particles, pulling water out of cells. Neurological impairment may be marked. DKA and HHS can overlap. Both require clinical fluid, electrolyte, insulin and cause-directed management. 1

Prevention is a care-system task

Maintain insulin access, follow an individualized sick-day plan, know when to check ketones, and seek help early when unwell. Do not stop insulin in Type 1. This page is not a home emergency-treatment protocol.

Trace the evidence

Sources and further reading

2.Diabetic Ketoacidosis (opens in a new tab)

US Centers for Disease Control and Prevention · 2024 · Reference

Established
Who was studied, limits and source check

Limitations: General patient education, not a substitute for emergency assessment.

Source checked 2026-09-30. See the original publication for full methods.

Source checking is an editorial literature check, not independent medical review. This page is for learning. It cannot diagnose you or make a treatment plan. Evidence labels describe the cited claims, not the whole topic.

What does “Established” mean?

Doctors and scientists agree. This is well known. Like “the sun rises in the east”.

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