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Key takeaways
People with diabetes should maintain healthy blood sugar levels to prevent long-term complications, aiming for a hemoglobin A1C less than 7% in adults, though individual targets may vary.
Low blood sugar (hypoglycemia) is considered to be below 70 mg/dl, with symptoms including dizziness, shaking, sweating, fast heartbeat, anxiety, confusion, and hunger; it should be treated promptly by consuming fast-acting carbohydrates.
The 15/15 rule suggests consuming 15 grams of fast-acting carbohydrates and retesting blood sugar after 15 minutes, repeating this process until blood sugar is above 70 mg/dl, to raise blood sugar levels quickly.
Preventing low blood sugar involves maintaining a healthy diet, being prepared with sources of fast-acting carbohydrates, checking blood sugar regularly, exercising carefully, and consulting with healthcare providers and a Certified Diabetes Care and Education Specialist (CDCES).
People with diabetes benefit from keeping blood glucose levels, or blood sugar levels, in their target range. Maintaining healthy blood sugar levels is the best way to prevent or delay long-term complications and serious health problems from diabetes and help people maintain overall health. According to the American Diabetes Association, the goal hemoglobin A1C, which is a measure of blood sugar control over a 3-month period, is generally less than 7% in adults but can vary based on individual factors. This goal does not apply to pregnant women with gestational diabetes.
Sometimes, blood sugar can become too high or too low. This article will focus on low blood sugar. Hypoglycemia is the medical term for low blood sugar levels in the body. Blood sugar is generally considered to be low when it is less than 70 mg/dl, but may vary slightly by the individual. When blood sugar is low, the person will need to eat or drink something to bring it back up into the target range, or normal range.
Signs and symptoms of low blood sugar
Blood sugar can be affected by many factors. Some possible causes of hypoglycemia include:
- Insulin: administering too much insulin, not eating enough carbohydrates for the amount of insulin that is injected, or incorrect insulin timing
- Certain diabetes medications such as glyburide, glimepiride, or glipizide
- Exercise or physical activity
- Alcohol (especially drinking too much alcohol without enough food)
- Illness
- Weather (heat and humidity)
- Altitude changes
- Hormonal factors such as puberty or menstruation
How will you know if you have low blood sugar? Testing your blood sugar, either with a blood glucose meter (which uses a finger stick to take a small blood sample to test) or by continuous glucose monitoring (CGM), will provide you with your blood glucose number. CGMs are becoming more popular (and affordable), do not require finger sticks (or only occasional finger sticks), and are updated continuously. Depending on the specific CGM, your blood glucose level will be updated every one to five minutes. In addition to knowing the blood glucose level, patients may feel symptoms of low blood glucose (less than 70 mg/dl), such as:
- Dizziness
- Shaking
- Sweating
- Fast heartbeat
- Anxiety
- Confusion
- Hunger
Severe low blood sugar symptoms (when blood sugar is less than 55 mg/dl) may include weakness, difficulty walking, confusion, strange behavior, seizures, or fainting.
Some people may not notice symptoms of low blood sugar. This is called hypoglycemia unawareness. People who experience hypoglycemia unawareness will need to check their blood sugar more often—especially before driving or physical activity.
How to raise blood sugar fast (treating low blood sugar safely and effectively)
Having low blood sugar is not a reason for panic—because it can be quickly treated. Low blood sugar should be quickly treated to prevent a further drop and to bring the blood sugar back into the target range.
People with diabetes should always keep some fast-acting carbohydrates with them, so they are accessible at all times. For example, keeping some candy in a pocket, purse, backpack, and/or car can be very helpful so that it is always accessible quickly if blood sugar drops below 70 mg/dl.
The 15/15 rule
Your healthcare provider will give you a treatment plan that will outline what to do in the event of low blood sugar. In most cases, you will be advised to consume a certain amount of carbohydrates—usually 15 grams of fast-acting carbohydrates—and then test your blood sugar again in 15 minutes. (More info on fast-acting carbohydrates is below.)
If after 15 minutes, your blood sugar is still below 70 mg/dl, you will need to eat another 15 grams of fast-acting carbohydrates. Repeat until your blood sugar is above 70 mg/dl. Keep track of low blood sugar episodes, and discuss them with your healthcare provider. If you frequently have low blood sugar problems, you may need a change to your insulin dose or diabetes medicines.
Note: Never give insulin to someone with low blood sugar. Insulin will lower blood sugar even further.
Fast-acting carbohydrates
When people think of carbohydrates, they may think of pasta and pizza. While these foods do raise blood sugar, they do so more slowly. Even sugary food such as dark chocolate or ice cream will not raise your blood sugar quickly enough because they also contain protein and fat.
When you need to raise your blood sugar quickly, you will want to consume a snack of fast-acting carbohydrates. This type of sugar works quickly to increase blood glucose levels. Check the label for the serving size which contains about 15 grams of carbohydrates. You can discuss the best options with your healthcare provider. Generally, the following can be used:
- Smarties (2.5 packs)
- Glucose tablets, glucose gel, or other specifically formulated glucose products
- 4 ounces of apple juice or other fruit juice or sugary drink
- 4 ounces of regular (not diet) soda
- Skittles
- Jellybeans
- Cake frosting
- Gummy bears
Dangerously low blood sugar
Blood sugar that is below 55 mg/dl is generally considered to be dangerously low. At this level, you may not be able to eat or check your own blood sugar. There is a prescription medication called glucagon which is available as an injection or nasal spray (the nasal spray is called Baqsimi), that a family member, friend, or caregiver can administer to you in the event of a low blood sugar emergency. Ask your doctor if you need a prescription for a glucagon kit. If so, learn how and when to use it, and show your close friends, family, and caregivers how to use it in case of emergency. You should also wear medical identification, like a bracelet, that notifies first responders that you have diabetes in case of an emergency.
How to prevent low blood sugar
Here are some tips you can try to help avoid low blood sugar levels.
Maintain a healthy and consistent diet
People with diabetes benefit from eating a healthy diet and eating meals and snacks at regular intervals with appropriate amounts of carbohydrates to keep blood sugar levels in the target range. The glycemic index ranks carbs on a scale of 0 to 100 based on how they affect blood sugar levels. Certain foods, like white bread, have a high glycemic index and can cause large spikes in blood sugar. Foods with a low glycemic index, like whole grains and leafy greens, lead to a smaller rise in blood sugar—as do lean proteins like fish and chicken. If you consume alcohol, talk to your doctor about a safe amount to consume, and if and when you do drink alcohol, have it with food, not on an empty stomach.
You may want to consult with a registered dietician who specializes in diabetes and can help pinpoint which foods work best for your blood sugar levels. CGMs can also help you identify how certain foods affect your blood sugar.
Be prepared
Sometimes, a low blood sugar level will occur. It is best to always be prepared. Keep sources of fast-acting carbohydrates near you at all times. For example, you may want to keep snack-size bags of candy and 4-ounce juice boxes near your bed, as well as in the kitchen, in your purse or a backpack, and in your car (if weather allows). If you are at risk for low blood sugar levels, it’s important to get into the habit of always having fast-acting carbs with you. This way, you will never get caught in a situation where you are standing in a long line to purchase food while your blood sugar levels are falling.
Check blood sugar regularly
Consult with your physician about the best way to check your blood sugar levels. Some people prefer to finger stick and use a blood glucose meter, while others prefer the technology of a CGM. The best method is the one that works best for you and that you will use. If you inject insulin—or if you just avoid your blood glucose meter because you don’t like finger sticks, a CGM may be a better option. Or, if you dread technology, you may prefer a blood glucose meter.
Be careful with exercise
Regular exercise is important for everyone. However, people with diabetes need to be more mindful of blood sugar levels during exercise. Exercise may lower blood sugar, not only during the activity itself—but for many hours after exercise. Your treatment plan will include information about blood sugar levels and exercise. If your sugar is a little low, you may need to eat a snack before exercising in order to prevent hypoglycemia.
Talk to your doctor and CDCES
Everyone has a unique medical background and may have individual factors that can increase the risk of low blood sugar. Talk with your doctor and diabetes care team. Ask your doctor if they work with—or can refer you to—a Certified Diabetes Care and Education Specialist (CDCES) or locate one online. A CDCES is a healthcare professional with extensive knowledge of diabetes who provides education and support to patients. A CDCES can be an important part of your healthcare team.
When to seek medical attention
Diabetes can be overwhelming, especially when someone is newly diagnosed. A treatment plan outlines what to do in every scenario, but sometimes you may feel unsure or have questions. Anytime you have questions or concerns, consult your healthcare provider or CDCES.
Many patients have trouble affording their insulin or diabetes medications and end up taking less than required or rationing their insulin to make it last longer. This can be dangerous. In this case, it is best to be honest with your healthcare provider. There are ways to save on insulin and diabetes medications such as manufacturer coupons, choosing generics when available, or using a free SingleCare prescription discount card.
If you have low blood sugar which is between 55 mg/dl and 69 mg/dl, you can generally treat it yourself. However, if your blood sugar drops below 55 mg/dl, you may require emergency treatment with glucagon. Ensure that your family, friends, and caregivers know how to help in an emergency situation. Your healthcare provider will give you specific instructions on what blood sugar level (and/or symptoms) will require glucagon.
If you receive glucagon, you should get emergency medical help immediately after. Other situations that will require a call to 911 include:
- If you pass out, and there is no glucagon available
- If you need a second glucagon dose
- If you had glucagon but are still confused
- If your blood sugar remains too low 20 minutes after treatment or is not responding to your usual low blood sugar treatments
- Anytime you are concerned about severely low blood sugar
If you are not sure if you need emergency help, it’s best to call 911 and go to the emergency room. According to the American College of Emergency Physicians, “Anyone who thinks they’re having a medical emergency should not hesitate to seek care. Federal law ensures that anyone who comes to the emergency department is treated and stabilized, and that their insurance provides coverage based on symptoms, not a final diagnosis.”