Severe hypoglycemia — a very low glucose with altered consciousness, seizure, or inability to swallow — glucagon/IV dextrose per order and escalate/transfer.

DKA / hyperosmolar state — high glucose with ketones, Kussmaul breathing, dehydration, or altered mentation — escalate/transfer.

Diabetic-foot emergency — spreading infection, gangrene, or a deep ulcer with systemic signs — notify urgently; sepsis → transfer.

Severe electrolyte disturbance with the crisis — escalate/transfer.