The two emergencies: a hypo and DKA
A hypo comes on in minutes and needs sugar now. DKA builds over hours and needs a hospital. How to tell them apart and what to do.
When drugs or alcohol are involved, there are two ways things tend to go wrong for someone with type 1: blood sugar that drops too low, or blood sugar and ketones that climb too high. This page explains the difference, what each one looks like, and exactly what to do.
Fast versus slow
The most useful way to hold these two in your head is speed.
Too low — a hypo — is the fast one. It comes on in minutes. Stimulants, alcohol, dancing all night and not eating can all bring it on. Left untreated, it can lead to seizures and unconsciousness. A hypo needs sugar, now.
Too high — DKA — is the slow one. Diabetic ketoacidosis builds over hours. Insulin gets missed, ketones pile up, and the blood becomes acidic. It does not fix itself, and it can land people in intensive care. DKA needs a hospital.
This isn't a bad comedown. It's DKA.
After a night out, feeling terrible can seem normal. But some of what looks like a rough comedown is actually DKA, and the difference matters.
It's worth saying out loud: nobody has ever been in trouble for arriving at an emergency department with ketones. It is the delay that does the damage. If you're unsure whether you're sick from the drug or from DKA, check and go.
Fixing a hypo: the 15 rule
In a real hypo, you won't be reading a web page. The sequence has to already be in your head — and in the heads of the people you're with — so it's worth rehearsing.
Two things that don't work: diet drinks do nothing for a hypo, and chocolate is too slow — the fat holds the sugar back.
Why these two matter more with drugs on board
Both emergencies are part of everyday life with type 1. What changes with drugs or alcohol is that the usual warning signs get blurred — a hypo can feel like being high or drunk, and DKA can feel like a hangover or a comedown. That's why the answer on every page of this section is the same: check your actual numbers, including ketones when you're vomiting, and make sure someone with you knows what to do.
The page What your friends should know covers how the people around you can spot a hypo and when they should call 911.