Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than the standard range. People with type 1 and type 2 diabetes may experience hypoglycemia and its symptoms when their blood sugars become too low, usually 70 mg/dl or below. Many people who have diabetes are at risk of a hypoglycemic event, especially those that take insulin and/or oral medications for type 1 or type 2 diabetes. Managing diabetes successfully involves balancing your meal plan with physical activity and medications. All 3 of these components work together to keep blood sugar within a normal range. If any of these get out of balance, you may experience high or low blood sugar. Hypoglycemia can be due to meals or snacks that are too small, delayed or skipped, increased physical activity, or drinking alcoholic beverages.  


It is important to be aware of the symptoms of hypoglycemia and to be prepared at all times should you experience it. 


Common Symptoms of hypoglycemia: 

  • Shakiness  
  • Sweating, chills, and clamminess  
  • Confusion or difficulty concentrating  
  • Nervousness  
  • Dizziness or lightheadedness   
  • Rapid/fast heartbeat   
  • Hunger or nausea  
  • Sleepiness   
  • Headaches  
  • Looking pale  
  • Becoming irritable or anxious  


Hypoglycemia can also happen while you sleep.   Be aware of signs such as nightmares, excessive sweating while you sleep, and being confused and irritable when you wake up, as these may be signs of a hypoglycemic event.    If you notice any of these symptoms it is important to check your blood sugar right away.   A blood sugar below 70mg/dl, should be treated.   Low blood sugar can continue to drop very quickly so do not delay.   


Use the 15-15 rule:  

  • Eat or drink 15 grams of carbohydrates    
  • Recheck your blood sugar in 15 minutes   


If your blood sugar is still low when you recheck it, repeat the steps until it is back to normal. When the blood sugar is normal again, eat a meal or snack – consisting of carbohydrates and protein to help keep blood sugar stable and prevent another low. The 15-15 rule is designed to not over treat blood sugar.  By keeping the carbohydrates to 15 grams of fast-acting carbohydrates, the blood sugar will go up, but it will not go from hypoglycemia to hyperglycemia.  


Examples of 15 grams of fast-acting carbohydrates include:  

  • 4 glucose tablets (get these at your pharmacy, confirm by looking at the label as some products vary)   
  • 4oz of fruit juice   
  • 1 tablespoon of sugar or honey 
  • 5-6 lifesavers  
  • 6 large jellybeans   
  • 4 oz regular soda   

Your carbohydrate choice to treat a low blood sugar should be a fast-acting carbohydrate, meaning it needs to be a food or drink that is all carbohydrates and not contain fat, fiber, or protein as this will delay the rate of digestion and take too long to bring up the blood sugar. Your normal meal plan will likely  not include these simple carbohydrate foods, so it is good to be prepared and have some of these on hand.   When your blood sugar is low, these sugary food items and drinks can save your life.   Once your blood sugar returns to normal, eat a snack or if it is time for your next meal, have your meal. Eating a meal or snack at this time will help keep blood sugar stable and prevent it from dropping again.   


Hypoglycemia can become a medical emergency if blood sugar becomes extremely low and you may become confused or pass out.   If you are someone who is at risk for hypoglycemia, it is important to let others know about your diabetes diagnosis and in an emergency teach them how to best help you.   If you are unable to swallow and treat your blood sugars with fast-acting carbohydrates, an emergency medicine called glucagon can be used.  Your doctor can prescribe this medication to have on hand should an emergency arise.  Glucagon is a medicine that tells your body to release glucose into your blood to help quickly raise your blood sugar.  Wearing a medical ID bracelet to alert people that your have diabetes and carrying glucagon with you are two things that can help if you are in crisis with your blood sugar.  Preventing low blood sugars should be part of your diabetes care plan.  Taking steps to lower your risk is important.    


Here are things that you can do to help prevent lows: 

  • Check your blood sugar regularly and often.  Checking blood sugar is the best way to determine if you are staying within your target blood sugar range.  Work with your health care provider to determine your blood sugar range and when it is best for you to monitor your blood sugars. If you have several readings below 70 mg/dl, they may need to adjust your medication, make changes to your meal plan and prescribe glucagon to have on hand for an emergency.  
  • Eat regular meals.  Timing of meals is an important piece to keeping blood sugars well controlled.  Skipping a meal can make blood sugars dip causing a hypoglycemic event.  If you can’t eat a meal, have a snack that combines a carbohydrate food and a protein food to help keep blood sugar stable until your next meal.  When you go for long hours without eating, your blood sugar can drop.  Having a small snack between meals can help prevent lows.  
  • Eat before physical activity.  Exercise can lower your blood sugar.  It can be helpful to plan exercise within an hour after having a meal or snack.  Check blood sugars before and after your activity to see if you are within your target range.   
  • If drinking alcohol, drink in moderation and consume it with a meal.  If you choose to have a drink, limit yourself to 1 drink for women or 2 drinks for men and only drink when eating, do not drink on an empty stomach.  
  • Sick day management.  If you are sick and unable to eat, you run the risk of having a low blood sugar.  Talk to your health care provider about a sick day plan and call them when you are sick to ask what you can do to prevent low blood sugars.  They may have you lower your medication dose or have you drink beverages that have some carbohydrates to help keep blood sugar within your target range.   
  • Always carry a snack with you and a fast-acting carbohydrate.  When away from your home you can run into situations where your next meal is delayed.   Maybe you are at a restaurant and there is an hour wait for a table or maybe you have an appointment that the wait time exceeded how long you thought you would be there.  These are times that a meal or snack may be delayed which can cause blood sugar to drop.  Being prepared with a snack can help prevent low blood sugars.   Carry a snack with you, such as a pack of crackers with cheese or peanut butter, a piece of fruit and a packet of nuts, a small bag of trail mix or a granola bar to eat in case your next meal is delayed.   Also make sure to keep those fast-acting carbohydrates on hand, like glucose tablets, a package of lifesavers, or small packets of sugar, should you experience a low blood sugar and need to bring it up quickly. 

For those that take mealtime insulin, you may need to take additional steps to prevent low blood sugars.   

  • Learning carbohydrate counting and knowing how many carbohydrates you are eating at your meal can help keep blood sugars within your target range.  Your health care provider may teach you how to dose your insulin based on how many carbohydrates you are eating at your meal.  Eating too little carbohydrates and taking too much insulin puts you at risk for a low blood sugar.  Learning about carbohydrate portions and following a meal plan which counts carbohydrates can help with blood sugar control.  
  • Adjusting insulin or carbohydrate intake for physical activity.  To keep blood sugars within target range, you may need to eat more carbohydrates before exercise or take less insulin.  If you exercise regularly and see any signs of low blood sugars, talk to your health care provider and they can help you make the necessary changes to help prevent lows when you are active.  

Follow these steps to be prepared.  Low blood sugars can happen when you have diabetes and it can be uncomfortable and sometimes dangerous.  Taking steps to manage and prevent hypoglycemia should be part of your diabetes management plan.