Hypoglycemia, or low blood sugar, is a frequent and urgent complication of diabetes management. This condition occurs when the body’s primary fuel source, glucose, drops to a level that impairs normal function. Since glucose is the main energy source for the brain, a rapid decline can quickly become serious. Learning to recognize the signs and administer the correct amount of sugar immediately is necessary for anyone managing diabetes or caring for someone who does.
Identifying the Signs of Hypoglycemia
The threshold for hypoglycemia is generally a blood glucose reading below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L). Symptoms can come on quickly and vary significantly from person to person or even from one episode to the next. Mild to moderate symptoms are the body’s warning system, indicating a need for immediate intervention.
Common signs include feeling shaky, dizzy, or lightheaded. You may also experience increased hunger, sweating, or a rapid or irregular heartbeat. As blood sugar levels continue to fall, symptoms can progress to confusion, difficulty concentrating, or irritability and anxiety. Testing the sugar level with a blood glucose meter is the most accurate way to confirm hypoglycemia. If symptoms are present but testing is not possible, treat the low blood sugar immediately.
The 15-15 Rule for Rapid Glucose Administration
The standard protocol for treating mild to moderate hypoglycemia is the “15-15 Rule,” which provides a precise, step-by-step method to raise blood sugar safely. The goal is to consume a measured amount of simple carbohydrate to quickly elevate glucose levels without causing an excessive spike. This process begins with consuming 15 grams of a fast-acting carbohydrate.
After consuming the 15 grams of carbohydrate, wait a full 15 minutes to allow the glucose to be absorbed into the bloodstream. The digestive system requires this time to break down the simple sugar and distribute it. It is important to resist the urge to consume more sugar during this waiting period, as this often leads to overtreatment and subsequent hyperglycemia.
Once the 15 minutes have passed, re-check the blood glucose level. If the level is still below 70 mg/dL (3.9 mmol/L), repeat the entire process: consume another 15 grams of fast-acting carbohydrate and wait another 15 minutes. This cycle continues until the blood sugar reading is back in a safe range.
Effective Sources of Fast-Acting Carbohydrates
The type of carbohydrate used to treat low blood sugar is just as important as the amount. Fast-acting carbohydrates are simple sugars that are absorbed quickly into the bloodstream. The best sources for the 15-gram dose are those that are low in fat and protein, as these nutrients slow down the rate of glucose absorption, delaying the necessary rise in blood sugar.
Specific examples that provide approximately 15 grams of fast-acting sugar include:
- Four glucose tablets, which are often the preferred choice due to their precise dosing.
- One-half cup (four ounces) of fruit juice or regular soda (not diet).
- One tablespoon of honey, syrup, or table sugar dissolved in water.
- Five to six small pieces of hard candy that can be chewed or dissolved.
When to Seek Emergency Medical Attention
Hypoglycemia that progresses to severe impairment requires immediate professional medical intervention. A situation becomes an emergency if the person loses consciousness, is having a seizure, or is unable to safely swallow food or liquid. Attempting to give an unconscious person sugar by mouth creates a serious choking hazard and should be avoided.
In these severe cases, emergency services should be called immediately. If a prescription for emergency glucagon is available, it should be administered by a trained caregiver or family member. Glucagon is a hormone that instructs the liver to release its stored glucose, rapidly raising the blood sugar level. Once the person is alert and able to swallow, a small snack or meal containing complex carbohydrates and protein should be consumed to prevent the blood sugar from dropping low again.