If you take insulin or other diabetes medications that work by making the body produce more insulin, you may be at risk of developing hypoglycemia, or low blood sugar. “In very severe cases, hypoglycemia can lead to seizures or loss of consciousness,” says Marilyn Tan, MD, a clinical assistant professor of medicine at Stanford Health Care and chief of the Endocrine Clinic at Stanford Health Care in Palo Alto, California.
Symptoms of low blood sugar vary from person to person. It’s possible to have no symptoms, or you may experience mild to moderate symptoms. You may:
Feel shaky or jittery
Sweat a lot
Be very hungry
Have a headache or be lightheaded
Have trouble concentrating
Have heart palpitations
Be irritable or combative
“Some people feel tingling or numbness in their extremities too,” says Rodolfo Galindo, MD, an endocrinologist with the University of Miami Health Systems in Florida.
How Do You Treat Hypoglycemia?
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Your Hypoglycemia Action Plan
Insulin and certain oral diabetes medications, such as sulfonylureas and meglitinides, can increase your risk of hypoglycemia. These medications all stimulate the pancreas to produce more insulin, which can contribute to low blood sugar levels. So, it’s important to always have some rapid-acting sugar with you in case you need to treat yourself. If you experience symptoms of hypoglycemia, take action with these steps.
Test your blood sugar. If you recognize any of these symptoms and believe your blood sugar may be too low, test your levels with your glucose meter, Dr. Tan says, even if you have a personal continuous glucose monitor (CGM). Anything less than 70 mg/dL is considered low. But target levels are often individualized, so talk with your healthcare provider about your optimal numbers, Tan adds.
Eat or drink fast-acting carbs. If you have low blood sugar, you need to take action right away. Your best bet is to consume about 15 grams (g) of carbohydrates. Some options include:
½ cup or 4 ounces (oz) of orange or apple juice
½ cup or 4 oz of regular soda (not diet)
1 tablespoon (tbsp) of sugar dissolved in water
1 tbsp of honey or maple syrup
3 hard candies
2 tbsp of raisins
½ cup of applesauce
You can also take three to four glucose tablets or a tube of glucose gel, Dr. Galindo says. It is important not to treat low glucose with foods like chocolate or cake. These foods are high in fat and may not allow the sugar to be absorbed quickly enough.
Wait 15 minutes, then retest. The next step is to wait 15 minutes, then test your blood sugar again. If it’s still less than 70 mg/dL, repeat the steps: Eat another 15 g of carbs, wait another 15 minutes, and retest. “You need to repeat these steps until your blood sugar is corrected,” Galindo says.
What to do when your blood sugar is back to normal. Once you feel better, it’s important to eat some protein and a carb to keep your blood sugar within normal range, Tan says. “A sandwich with ham or turkey is a good choice,” says Bruce Evans, a paramedic, a board member of the National Association of Emergency Medical Technicians, and the chief of the Upper Pine River Fire Protection District in Bayfield, Colorado. You can also snack on cheese and crackers. But once your blood sugar levels are stable again, you can otherwise resume your activities, Tan says.
When to call your doctor. If you’re having trouble keeping your blood sugar up, call your doctor or go to the nearest emergency room. You may also want to use glucagon, a hormone that tells your liver to release stored glucose. You can take it either as an injection (Gvoke) in the butt, thigh, or arm, or as an intranasal spray (Baqsimi). If you’re unable to administer it yourself, your friends and family can do it for you. Untreated hypoglycemia could cause you to have a seizure or lose consciousness.
How to Help Others Help You
It’s vital to know the signs and symptoms of low blood sugar, have an action plan, and be prepared with your glucose meter and glucose tablets. But sometimes you might need to rely on other people to help when your blood sugar drops too low, especially because low blood sugar can affect your thinking. Take these additional steps so you’re prepared and your friends and loved ones are, too.
Teach your loved ones. If you’re unable to help yourself, your friends, family, or colleagues may need to treat you with glucagon. It’s a good idea to carry an emergency glucagon kit and teach those close to you what to do. If they don’t know how to give you the injection or if glucagon isn’t available, they must call 911 and get you the help you need, Evans says. Complications of hypoglycemia can include cardiac arrhythmias, coma, organ failure, and irreversible brain damage, so it’s important to take action quickly.
Wear an ID bracelet. Evans suggests that everyone with diabetes should wear a medical ID bracelet or carry a wallet card. These identifiers should clearly note that you have diabetes and whether you’re on insulin or other medications.
Talk to your doctor about your low blood sugar risk. If you have frequent bouts of hypoglycemia, be sure to talk with your doctor. The solution may be changing how much or the kind of diabetes medication you take. Never make any changes to your medication regimen without your doctor’s approval. Your doctor may also advise getting a personal CGM to alarm you if your blood sugar is dropping before it gets too low.
The Takeaway
Know the signs and symptoms of low blood sugar. They include sweating a lot, feeling shaky or jittery, trouble concentrating, or heart palpitations. If you begin to experience any of these symptoms, consume 15 g of fast-acting carbs.
If your blood sugar drops below 70 mg/dL, take a fast-acting carb, such as 3 hard candies, 1 tbsp of honey or maple syrup, or 4 oz of juice or regular soda, then wait 15 minutes. If your blood sugar is still below 70 mg/dL, repeat these steps.
Once your blood sugar stabilizes and is within a healthy range, eat a protein-rich snack, such as cheese and crackers or a ham and cheese sandwich. Then, resume your activities.
If you experience low blood sugar often, speak with your doctor about next steps. They recommend changing your medications to prevent future episodes.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.
Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.
Beth W. Orenstein is a freelance writer for HealthDay, Radiology Today, the Living Well section of TheAmerican Legion Magazine, St. Luke’s University Health Network, and others. She is a magna cum laude graduate of Tufts University (1978), where she majored in English and was editor of the student newspaper for three years.
No matter the weather around her eastern Pennsylvania home, Orenstein either bikes 25 to 30 miles or walks at least 6 miles every day. Her one indulgence is blueberry pancakes — but only after biking a long distance.
