Low blood sugar, or hypoglycemia, is a common and potentially serious complication of diabetes. This condition requires a rapid, standardized response to restore glucose levels quickly and safely. The protocol for addressing mild to moderate hypoglycemia is known as the 15-15 rule.
Recognizing and Addressing Hypoglycemia
Hypoglycemia is defined as a blood glucose reading below 70 milligrams per deciliter (mg/dL). This low level triggers physical warnings, often starting suddenly with shakiness, sweating, and extreme hunger.
As blood sugar drops further, symptoms can progress to neuroglycopenic effects, reflecting a lack of glucose in the brain. These signs include confusion, lightheadedness, difficulty concentrating, or a rapid heart rate. Recognizing these symptoms quickly is important to initiate treatment before the condition worsens. Checking blood glucose with a meter is the most accurate way to confirm hypoglycemia and determine the need for the 15-15 rule.
Implementing the 15-15 Rule Protocol
The 15-15 rule is a three-step method recommended by health organizations, such as the American Diabetes Association, for treating mild to moderate hypoglycemia. The first step involves consuming 15 grams of a fast-acting carbohydrate. This amount is sufficient to raise blood glucose without causing an extreme spike, known as rebound hyperglycemia.
The carbohydrates used must be simple sugars that are easily and quickly absorbed into the bloodstream. Ideal sources contain minimal fat or protein, as these nutrients slow glucose absorption, delaying the treatment effect. Practical options for 15 grams of fast-acting carbohydrate include:
- Four glucose tablets.
- Half a cup (four ounces) of fruit juice or regular soda.
- One tablespoon of honey or table sugar.
- Specialized glucose gels.
- A small handful of soft candies, like six pieces of hard candy.
The second step is to wait 15 minutes after consuming the carbohydrate dose. This waiting period allows the digestive system to process the simple sugar and for the glucose to fully circulate and raise the blood glucose level. This step helps prevent overtreating the episode, which often leads to unnecessarily high glucose levels later.
After the 15-minute period, the third step requires re-checking the blood glucose level. If the reading is still below 70 mg/dL, the entire process must be repeated by consuming another 15 grams of fast-acting carbohydrate. This cycle of treat, wait, and re-check should be repeated until the blood glucose reading is above the threshold.
Post-Treatment Management and Prevention
Once blood sugar has risen above 70 mg/dL, the immediate crisis has passed. To prevent the blood sugar from dropping again after the fast-acting sugar is used, a follow-up action is necessary. If the person’s next scheduled meal is more than an hour away, they should consume a small snack.
This post-treatment snack should include both a complex carbohydrate and a source of protein or fat. Complex carbohydrates, such as whole-grain crackers or a small piece of fruit, provide a slower, sustained release of glucose. Pairing this with protein, like peanut butter or cheese, helps stabilize the blood sugar level over a longer duration.
If the 15-15 rule fails to raise blood glucose after two or three cycles, or if the person becomes confused, disoriented, or loses consciousness, immediate emergency medical attention is required. These symptoms indicate a severe hypoglycemic event requiring an emergency glucose injection, such as glucagon.