When to contact your team
The hardest thing to judge is manage-it-yourself versus pick-up-the-phone. A rough map of routine, urgent and 999 situations to agree with your team.
One of the hardest things to judge with type 1 is when something is a manage-it-yourself situation and when it is a pick-up-the-phone one. Getting a rough map of that in advance, agreed with your team, takes a lot of the guesswork out of a bad day.
- There are routine reasons to contact your team and urgent ones, and knowing which is which helps.
- The urgent flags are broadly: ketones with a high, vomiting, and not being able to keep fluids down.
- Some situations skip the team entirely and go straight to 999, and this page names those.
- ”I don’t know what is happening and it is not improving” is always a good enough reason to call.
- Your team can give you a personal version of all of this; the general shape is here, the specifics are theirs.
The non-urgent reasons, worth not sitting on
Plenty of reasons to contact your team are not emergencies but are worth not putting off. Patterns you cannot solve, a stretch where nothing behaves, meals that have stopped working, kit that keeps failing, sites that are running out, running low on supplies, or simply a question you have been carrying. These are the everyday reasons the team exists, and the specialist nurse line is usually the right door for them.
The reason to raise these earlier rather than later is that a small problem sorted is easier than a big one endured. A pattern caught early is a small adjustment; the same pattern left for months becomes a stretch of feeling rotten and a harder fix. Contacting the team about something undramatic is using them for exactly what they are for, not bothering them.
It also helps to know the difference between the nurse line and the general appointment route, so a question that needs a quick answer does not wait for a clinic slot months away. Ask your team what the best way to reach them is for a quick query versus a change of plan, because it differs between services.
The same-day flags
Some things mean contacting the team or the urgent care route the same day rather than waiting. The clearest is ketones together with a high that is not coming down, which is the early territory of something serious and is exactly what your sick day plan is written for. Being unwell with an illness, especially if your glucose is running high and hard to control, is another, because illness raises your insulin needs and can escalate over hours.
Vomiting deserves its own line, because it is the specific thing that turns manageable into urgent. If you are being sick, or cannot keep fluids and carbohydrate down, that stops you doing the ordinary things that keep you safe and it can tip into something dangerous quickly. That is a contact-the-team-or-111 situation, not a sleep-it-off one, and it is covered more fully in vomiting with type 1.
Repeated severe hypos, a low you struggled to treat, or lows that keep coming are also worth raising promptly rather than absorbing, because they are a pattern the team can do something about. And the honest catch-all: if you do not know what is happening, you have tried the obvious things, and it is not improving, that uncertainty is itself a reason to call. You do not have to have diagnosed the problem to be allowed to ask for help with it.
When it skips the team and goes to 999
Some situations are past a phone call to the clinic and are an emergency. If someone is unconscious, fitting, or so low they cannot swallow safely, that is 999, and glucagon if it is available and someone knows how to use it, not a call to the diabetes nurse. Severe hypoglycaemia that cannot be treated by mouth is a medical emergency.
Signs of diabetic ketoacidosis are the other emergency worth knowing in outline: high glucose with ketones, plus being sick, deep or fast breathing, breath that smells fruity, severe tummy pain, drowsiness or confusion. That combination is not a wait-and-see, it is urgent medical help, 999 or A and E, and it is the reason the ketones-plus-high flag above matters so much. It is covered in full in the DKA article.
The principle to hold onto is that these do not wait for the team’s opening hours, and using emergency services for them is correct rather than dramatic. Out of hours, 111 covers the gap between “worrying but not an emergency” and “call 999”, and it can help you decide which one you are in.
What changes the threshold
Being a pump user lowers the threshold, because there is no long-acting insulin behind a pump, so a problem becomes urgent faster. Living alone lowers it too, since there is nobody to notice things going wrong. And vomiting is the single factor that most often turns a manageable situation into one that needs the team or 111, whatever else is going on.
Which is which
Examples, not instructions or doses.
Meals behaving oddly for weeks. Not an emergency, but worth the nurse line rather than enduring for months.
A stubborn high plus ketones and feeling rough. A same-day call and your sick day plan, not a wait-and-see.
Someone unable to swallow safely. That is 999 and glucagon, not a call to the clinic.