Diabetes in DUI Cases

In the recent months we’ve consulted on a number of DUI and assault cases where the defendant had diabetes and elevated blood sugars. In every case the sugar was around 300-400, which just isn’t high enough to account for any changes in mental status, despite meeting the criteria for DKA. So I thought I would review diabetic emergencies for criminal attorneys in this month’s newsletter.

Diabetes Overview

Diabetes is a metabolic disorder characterized by the body’s inability to effectively process carbohydrates, leading to elevated levels of glucose in the bloodstream condition known as hyperglycemia. Type 1 diabetes arises from an autoimmune attack on the pancreas, which impairs its ability to produce insulin. Type 1 only accounts for 5-10% of adult diabetics. Type 2 diabetes is far more common in adults and is often caused by a loss of insulin secretions. These individuals can be asymptomatic but show high blood sugar levels upon routine blood work (Inzucchi & Beatrice, 2025). Type 2 Diabetics are more commonly diagnosed in their 40’s or older, but it can be difficult to diagnose as the disease progression is slow  (Inzucchi & Beatrice, 2025).

The ADA now also recognizes a condition called “prediabetes” in which the patient’s blood sugar levels are elevated, but are not high enough to be diagnosed as diabetes. If an individual is diagnosed as prediabetic, they have a greater risk of becoming a type 2 diabetic if they do not make dietary and lifestyle changes. Diabetes is also seen in pregnancy, called gestational diabetes; and it may be caused from other conditions or external causes such as drugs or chemicals.

Diabetic Emergencies – DKA

Diabetic Ketoacidosis or DKA occurs when there is not enough insulin in the body, so the liver starts breaking down fat and releasing ketones into the bloodstream (Cleveland Clinic, 2024). In patients with DKA, elevated blood sugar levels are accompanied by a significant buildup of ketones, which makes the bloodstream highly acidic and leads to severe dehydration (Cleveland Clinic, 2024). The symptoms of diabetic ketoacidosis (DKA) depend on the concentration of ketones and the level of blood glucose in the body. Early warning signs and symptoms include:

• Frequent urination
• Extreme thirst
• Intense hunger
• High blood sugar levels (250 mg/ml or greater)
• Headache
• Dry mouth

Severe symptoms of DKA include:

• Nausea
• Vomiting
• Severe abdominal pain
• Rapid, deep breathing
• Fatigue
• Fruity-smelling breath
• Confusion / disorientation
• Loss of consciousness

Stress, illness, dehydration and vomiting are some contributing factors that can cause a diabetic to go into DKA. This complication can have a very rapid and sudden onset, especially if the individual has been vomiting (Cleveland Clinic. 2024). If not recognized and treated in time, DKA can be fatal.

Diabetic Emergencies – Hypoglycemia

Hypoglycemia is a condition where there is not enough glucose in the body, resulting in low blood sugar levels. Blood sugar levels can drop because of malnourishment or inadvertent overdose of insulin. They may also drop due to increased energy demands by the body such as illness or stress. Blood sugar at or below 70 mg/dL is considered low and can be harmful (Jose Joaquin Lado Abeal, 2024). A blood sugar level of 50 mg/dL or lower can pose a serious, potentially life-threatening risk to diabetics. (Jose Joaquin Lado Abeal, 2024).

Many diabetics will recognize their personal signs of hypoglycemia and eat something to bring their sugar levels back up. However, there are many diabetics who fall into a coma or seizure because their blood sugar drops quickly, and they don’t feel the “warning signs” that their sugar is low. Like DKA, hypoglycemia can range from mild to severe symptoms – including death. Hypoglycemic signs and symptoms include:

• Blurry vision
• Confusion
• Dizziness
• Anxious feeling
• Irritability
• Headache
• Hunger
• Racing heartbeat
• Shaking
• Sweating
• Weakness

Conclusion

Individuals with Type 1 diabetes are especially vulnerable to diabetic emergencies because they rely solely on external insulin to regulate their blood sugar. Insulin dosing is complex, influenced by factors such as current glucose levels, timing of the last meal, and other variables. These needs can shift rapidly due to illness, stress, or dietary changes. Those who are not consistent in monitoring their blood sugar are at a significantly higher risk for serious complications like diabetic ketoacidosis (DKA) and hypoglycemia.

People with Type 2 diabetes still produce some insulin, which generally makes them less susceptible to acute diabetic emergencies. However, they can still experience both diabetic ketoacidosis (DKA) and hypoglycemia, particularly during periods of stress or illness. Symptoms often arise when individuals neglect to eat or miss their prescribed medications.

In criminal cases, the medical records of diabetics should be reviewed and analyzed as a potential cause for abnormal behavior. Even if the blood sugar is normal, there may be other issues that are related to diabetes and are contributing to the criminal behavior; such as medications or other health conditions commonly associated with diabetes.