When do I need in-person or emergency care instead?
Written and medically reviewed by Zahraa Sater, M.D., M.P.H.
Reviewed August 12, 2026 · Next review due August 12, 2028
Short answer
Call 911 or go to an emergency department for chest pain, severe low blood sugar, symptoms of diabetic ketoacidosis, thyroid storm, adrenal crisis, severe abdominal pain on a GLP-1, or thoughts of suicide. A telehealth appointment is scheduled care. It cannot examine you, treat you today, or admit you to hospital.
Get urgent care if: call 911 or go to an emergency department now if you have any of the following.
- Chest discomfort, breathlessness, or pain in the arm, jaw, neck, back or upper stomach
- Low blood sugar with confusion, seizure or loss of consciousness, or a reading you cannot bring up after repeated treatment
- High glucose with vomiting, stomach pain, deep rapid breathing, fruity smelling breath or reduced alertness, which can indicate diabetic ketoacidosis
- Fever, a pounding rapid heartbeat, sweating, agitation or confusion in someone with an overactive thyroid, which can indicate thyroid storm
- Severe abdominal or flank pain with vomiting, dizziness, low blood pressure or collapse in someone on steroid replacement, which can indicate adrenal crisis
- Severe persistent pain in the upper abdomen radiating to the back while taking a GLP-1 medication, with or without vomiting
- Thoughts of suicide or harming yourself: call or text 988 in the United States, or go to an emergency department
Telehealth is scheduled care, and some endocrine problems cannot wait for a scheduled appointment. Several endocrine emergencies also look mild in the first hours and then deteriorate quickly, which is exactly why the decision to go in should not depend on how bad you feel at that moment. If a situation below applies, stop reading and get emergency care.
Situations that need emergency care now
Emergency care means calling 911 or going to an emergency department, not waiting for a message reply. Chest discomfort, breathlessness, or pain in the arm, jaw, neck or back can be a heart attack, and MedlinePlus advises calling 911 even if you are not sure. Severe low blood sugar with confusion, seizure or loss of consciousness needs glucagon and 911. Diabetic ketoacidosis presents with deep rapid breathing, fruity smelling breath, vomiting and reduced alertness. Thyroid storm presents with fever, a pounding fast heart rate, agitation and confusion in someone with an overactive thyroid. Adrenal crisis presents with severe abdominal or flank pain, vomiting, low blood pressure, confusion and collapse. For thoughts of suicide or self harm, call or text 988 in the United States, or go to an emergency department. The 988 Suicide and Crisis Lifeline is free, confidential and answers 24 hours a day.
Situations that need same day in person care
Some problems are not 911 emergencies but still need hands and cannot be handled over video. Persistent vomiting on a GLP-1 with no urine output or dizziness on standing needs assessment for dehydration and kidney injury. A rapidly enlarging neck lump, a hoarse voice with a thyroid nodule, or difficulty swallowing needs examination. A foot ulcer, a hot swollen foot or a spreading skin infection in someone with diabetes needs to be seen the same day. New severe headache with visual change in someone with a pituitary condition needs urgent imaging.
| Symptom | Where to go |
|---|---|
| Chest pain or breathlessness | 911 or emergency department |
| Confusion, seizure or unresponsiveness at any glucose level | 911 |
| Vomiting with deep rapid breathing and high glucose | Emergency department |
| Severe abdominal pain radiating to the back on a GLP-1 | Emergency department |
| Diabetic foot ulcer or spreading redness | Same day, in person |
| Thyroid dose question or a stable lab result | A scheduled telehealth visit |
What a virtual visit cannot do
A virtual endocrinology visit cannot examine your abdomen, measure your blood pressure lying and standing, give intravenous fluids, run an ECG or admit you. Messages are not monitored continuously and are not a route for anything urgent. If you are unsure whether a situation is urgent, treat it as urgent and get assessed in person; an unnecessary emergency visit is a far smaller problem than a missed adrenal crisis or ketoacidosis.
If you take insulin, a sulfonylurea or steroid replacement, keep the emergency plan ready before you need it: glucagon in the house, a sick day rule for steroid dosing, ketone strips if you have type 1 diabetes, and someone who knows what to do.
The clinical detail
Thresholds that change the disposition: blood glucose below 54 mg/dL is clinically significant hypoglycaemia and requires immediate treatment, and any hypoglycaemia with altered consciousness or seizure is severe by definition and needs glucagon plus emergency services. Ketoacidosis should be suspected with hyperglycaemia plus ketones, vomiting or Kussmaul breathing, and can occur at near normal glucose in euglycaemic ketoacidosis, particularly with SGLT2 inhibitors.
Steroid sick day rules apply to anyone on replacement glucocorticoid: oral dose doubling for fever or intercurrent illness, and parenteral hydrocortisone with emergency transport for vomiting, collapse or reduced consciousness, because oral dosing cannot be absorbed in that state.
Written and medically reviewed by Zahraa Sater, M.D., M.P.H.
Reviewed August 12, 2026 · Next review due August 12, 2028
Sources
- Heart Attack. MedlinePlus, National Library of Medicine
- Diabetic ketoacidosis. MedlinePlus Medical Encyclopedia, National Library of Medicine
- Thyroid storm. MedlinePlus Medical Encyclopedia, National Library of Medicine
- Acute adrenal crisis. MedlinePlus Medical Encyclopedia, National Library of Medicine
- Low Blood Glucose (Hypoglycemia). National Institute of Diabetes and Digestive and Kidney Diseases
- WEGOVY (semaglutide) injection, prescribing information. U.S. Food and Drug Administration
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