What to Do During a Hypoglycemia Attack: A Step-by-Step Guide

18 Sep 2025 By Victor M. Montori, M.D.

What to Do During a Hypoglycemia Attack: A Step-by-Step Guide

Hypoglycemia, or low blood sugar, can be a frightening experience, especially if you or someone you're with is experiencing a severe episode. Understanding how to react quickly and effectively is crucial for managing the situation and preventing serious complications. This comprehensive guide provides a step-by-step approach to handling a hypoglycemia attack, focusing on immediate actions, monitoring, and when to seek professional medical help. The Top 5 Questions About Hypoglycemia Answered By An Expert

Why Understanding Hypoglycemia Matters:

Hypoglycemia occurs when the level of glucose (sugar) in your blood drops too low. Glucose is the primary source of energy for the body, and the brain is particularly sensitive to low glucose levels. For individuals with diabetes, especially those using insulin or certain oral medications, hypoglycemia is a common risk. Recognizing the symptoms and knowing how to treat it promptly can save lives and prevent severe complications, such as seizures, loss of consciousness, or even brain damage.

Understanding Hypoglycemia: Causes, Symptoms, and Risks

Before diving into the step-by-step guide, it's essential to grasp the basics of hypoglycemia.

Causes:

Excessive Insulin or Medication: Taking too much insulin or certain oral diabetes medications.
Missed or Delayed Meals: Not eating enough or skipping meals.
Intense Exercise: Engaging in strenuous physical activity without adjusting medication or increasing food intake.
Alcohol Consumption: Alcohol can interfere with glucose production in the liver, especially when consumed on an empty stomach.
Kidney or Liver Problems: These conditions can affect how the body processes insulin and glucose.
Certain Medical Conditions: Some tumors or hormone deficiencies can also cause hypoglycemia.

Common Symptoms:

Shakiness or tremors
Sweating
Rapid heartbeat
Anxiety or nervousness
Irritability or confusion
Dizziness or lightheadedness
Blurred vision
Headache
Weakness or fatigue
Difficulty concentrating

Potential Risks:

Seizures
Loss of consciousness
Brain damage (in severe, prolonged cases)
Increased risk of falls and accidents
Coma

Recognizing these causes, symptoms, and risks is the first step in being prepared to handle a hypoglycemia attack. Let’s move on to the step-by-step guide.

Step-by-Step Guide to Handling a Hypoglycemia Attack

This guide provides a detailed, actionable plan for effectively managing a hypoglycemia attack. Each step is designed to ensure a swift and appropriate response, whether you're assisting someone else or experiencing the episode yourself.

Step 1: Recognize the Symptoms Immediately

The faster you recognize the symptoms of hypoglycemia, the quicker you can take action. Refer to the list of common symptoms provided earlier and be especially vigilant if you have diabetes or are caring for someone who does. Keep in mind that symptoms can vary from person to person and may change over time for the same individual.

Example:

Imagine you're at a family gathering, and your grandfather, who has diabetes, suddenly becomes unusually quiet and starts sweating profusely. He also seems confused when you ask him a simple question. These could be early signs of hypoglycemia.

Step 2: Test Blood Sugar Levels (If Possible)

If a blood glucose meter is available, test the person's blood sugar immediately. This provides objective confirmation of hypoglycemia.

Target Range: Generally, a blood sugar level below 70 mg/dL (3.9 mmol/L) is considered hypoglycemia.
No Meter Available: If a meter isn't available, don't delay treatment. Proceed with the assumption that it's hypoglycemia based on the symptoms.

Step 3: Administer Fast-Acting Carbohydrates

The primary goal is to raise blood sugar levels quickly. Fast-acting carbohydrates are the best option. Here are some examples:

Glucose Tablets: Follow the package instructions. Typically, 3-4 tablets (15-20 grams of glucose) are recommended.
Glucose Gel: Similar to tablets, follow package instructions for dosage.
Fruit Juice: 4 ounces (120 ml) of regular (not diet) fruit juice.
Regular Soda: 4 ounces (120 ml) of regular (not diet) soda.
Hard Candies: 3-4 pieces of hard candy (chewed or sucked).
Honey or Sugar: 1 tablespoon of honey or sugar.

Important Considerations:

Avoid Fatty Foods: Foods high in fat (e.g., chocolate, nuts) can slow down the absorption of glucose.
Avoid Diet Drinks: Diet drinks do not contain sugar and will not raise blood glucose levels.
Consciousness Required: Ensure the person is conscious and able to swallow safely before administering anything by mouth.

Example:

If your grandfather can swallow safely, give him 4 glucose tablets (following the dosage instructions) or 4 ounces of regular fruit juice.

Step 4: Recheck Blood Sugar After 15 Minutes

After administering fast-acting carbohydrates, wait 15 minutes and then recheck the blood sugar level using a glucose meter. This is known as the "15-15 rule."

If Blood Sugar is Still Below 70 mg/dL: Administer another dose of fast-acting carbohydrates and wait another 15 minutes before rechecking.
If Blood Sugar is Above 70 mg/dL: Proceed to Step 5 to stabilize blood sugar levels.

Why the 15-Minute Wait?

It takes approximately 15 minutes for the body to absorb the glucose and for blood sugar levels to rise. Checking too soon can lead to overcorrection and potentially cause hyperglycemia (high blood sugar). Understanding Your A1C Test What Hba1C Results Mean For Diabetes Management

Step 5: Consume a Longer-Acting Carbohydrate and Protein Snack

Once blood sugar levels are above 70 mg/dL, it's essential to stabilize them and prevent a recurrence of hypoglycemia. This is achieved by consuming a snack that contains both carbohydrates and protein.

Good Snack Options:

Crackers with peanut butter
Cheese and whole-wheat bread
A small glass of milk with a piece of fruit
Yogurt with granola

Why a Combination of Carbs and Protein?

Carbohydrates provide an immediate source of glucose, while protein helps to slow down glucose absorption and provide sustained energy.

Example:

After your grandfather's blood sugar rises above 70 mg/dL, give him a few crackers with peanut butter. This combination will help to maintain his blood sugar levels. Your Guide To Reading A Normal Blood Sugar Chart

Step 6: Monitor for Recurrence

Even after blood sugar levels have stabilized, continue to monitor for any signs of recurring hypoglycemia, especially in the hours following the initial episode.

Things to Watch For:

Return of initial symptoms (shakiness, sweating, confusion)
Unexplained mood changes
Difficulty concentrating

If Symptoms Return:

Repeat the steps for administering fast-acting carbohydrates and follow the 15-15 rule.

Step 7: When to Seek Emergency Medical Assistance

In certain situations, hypoglycemia requires immediate medical attention. Call emergency services (911 in the US) if:

The person is unconscious or unable to swallow.
The person is having a seizure.
The person's blood sugar remains dangerously low (below 40 mg/dL) despite treatment.
You are unable to effectively raise the person's blood sugar levels.
The person is pregnant and experiencing hypoglycemia.
There is no known history of diabetes, and the cause of hypoglycemia is unclear.

Glucagon Injection:

If the person is unconscious or unable to swallow, and you have access to a glucagon emergency kit, administer a glucagon injection according to the package instructions. Glucagon is a hormone that can rapidly raise blood sugar levels. It's crucial to have a glucagon kit available if you or someone you care for is at risk of severe hypoglycemia. Note that even after glucagon is administered, emergency medical assistance should be sought.

Preventative Measures to Avoid Future Hypoglycemia Attacks

Prevention is just as crucial as treatment when it comes to hypoglycemia. Addressing the underlying causes can significantly reduce the risk of future episodes. Here are some preventative measures:

1. Consistent Meal Timing

Eat Regular Meals: Avoid skipping or delaying meals. Consistent meal timing helps maintain stable blood sugar levels.
Snack Smart: If there are long intervals between meals, consume a healthy snack to prevent blood sugar from dropping too low.

2. Medication Management

Adhere to Prescribed Dosage: Take diabetes medications (especially insulin) exactly as prescribed by your healthcare provider.
Coordinate with Exercise: Adjust medication dosage or food intake based on your activity level, as advised by your doctor.
Regular Monitoring: Frequently check blood sugar levels, especially before meals, before bedtime, and after exercise.

3. Alcohol Awareness

Consume with Food: If drinking alcohol, do so in moderation and always with food.
Monitor Blood Sugar: Check blood sugar levels more frequently when consuming alcohol, as it can interfere with glucose production.

4. Education and Awareness

Know Your Symptoms: Be familiar with the early warning signs of hypoglycemia and educate family members and caregivers.
Medical ID: Wear a medical identification bracelet or necklace indicating you have diabetes and are at risk of hypoglycemia.
Emergency Kit: Keep a hypoglycemia emergency kit (including glucose tablets, glucagon, and instructions) readily available at home, work, and when traveling.

5. Regular Consultations with Healthcare Provider

Review Treatment Plan: Regularly discuss your diabetes management plan with your healthcare provider.
Medication Adjustments: Work with your doctor to adjust medication dosages based on blood sugar levels, lifestyle changes, and overall health.
Identify Underlying Causes: If hypoglycemia occurs frequently, work with your healthcare provider to identify and address the underlying causes.

Example:

Work with your doctor or diabetes educator to develop a detailed meal plan and insulin schedule that takes into account your activity level, food preferences, and blood sugar readings.

Advanced Strategies: Continuous Glucose Monitoring (CGM) and Insulin Pumps

For individuals with diabetes who experience frequent or severe hypoglycemia, advanced technologies such as continuous glucose monitoring (CGM) and insulin pumps can provide significant benefits.

Continuous Glucose Monitoring (CGM)

Real-Time Monitoring: CGMs continuously track blood glucose levels throughout the day and night, providing real-time readings and trend information.
Alerts and Alarms: CGMs can be programmed to alert you when blood sugar levels are dropping too low or are approaching a hypoglycemic range.
Improved Control: By providing continuous data, CGMs can help you make more informed decisions about insulin dosage, food intake, and physical activity.

Data Example:

A CGM report might show that your blood sugar consistently drops in the late afternoon. Armed with this information, you can adjust your lunchtime insulin dose or add a snack to prevent hypoglycemia.

Insulin Pumps

Precise Insulin Delivery: Insulin pumps deliver a steady stream of insulin throughout the day and can be programmed to deliver bolus doses before meals.
Reduced Risk of Hypoglycemia: Pumps can be programmed with features like "suspend before low," which automatically reduces or stops insulin delivery when blood sugar levels are predicted to drop too low.
Improved Flexibility: Pumps offer greater flexibility in meal timing and physical activity compared to traditional insulin injections.

Combining CGM and Insulin Pump:

When used together, CGM and insulin pumps can create a "closed-loop" system, where the pump automatically adjusts insulin delivery based on real-time glucose readings from the CGM. This can significantly improve blood sugar control and reduce the risk of hypoglycemia.

Scientific Research and Data

Several studies support the benefits of CGM and insulin pumps in reducing the risk of hypoglycemia. For example, a study published in the Journal of the American Medical Association found that adults with type 1 diabetes who used a CGM and insulin pump experienced a 27% reduction in severe hypoglycemia compared to those using traditional methods.

| Technology | Benefit | Supporting Evidence | | :------------------- | :--------------------------------------------------------- | :------------------------------------------------------------------------------------------------------------------- | | Continuous Glucose Monitoring (CGM) | Real-time alerts and alarms to prevent hypoglycemia | Journal of the American Medical Association study showing improved glycemic control and reduced hypoglycemia | | Insulin Pumps | Precise insulin delivery and automated features | Research indicates pumps reduce the incidence of severe hypoglycemia by allowing tailored insulin adjustments |

In conclusion, recognizing the symptoms of hypoglycemia and acting quickly are essential for managing a hypoglycemia attack effectively. By following this comprehensive step-by-step guide, you can respond appropriately and prevent serious complications. Moreover, implementing preventative measures and exploring advanced technologies can further reduce the risk of future episodes and improve overall diabetes management. Always consult with your healthcare provider to develop a personalized plan tailored to your individual needs and circumstances.