What to Do During a Low Blood Sugar Event: A Step-by-Step Guide

18 Sep 2025 By Ricky Buckshaw, Jr., D.O.

What to Do During a Low Blood Sugar Event: A Step-by-Step Guide

A low blood sugar event, also known as hypoglycemia, occurs when the level of glucose (sugar) in your blood drops too low. For most people with diabetes, this is considered to be below 70 mg/dL (3.9 mmol/L). Recognizing the symptoms and taking immediate action is critical to prevent serious complications. This guide provides a step-by-step approach to manage a low blood sugar event effectively, ensuring your safety and well-being.

Why is it important to act quickly?

Hypoglycemia can lead to various symptoms ranging from mild shakiness and sweating to severe confusion, seizures, or even loss of consciousness. Prolonged or severe hypoglycemia can be dangerous and may require emergency medical attention. Being prepared and knowing how to respond can make a significant difference in managing the situation and avoiding potential harm.

Quick Overview: Steps to Take During a Low Blood Sugar Event

Recognize the Symptoms: Identify the common signs of hypoglycemia.
Check Your Blood Sugar: Confirm your blood sugar level with a glucose meter.
Treat Immediately: Consume a fast-acting carbohydrate source.
Wait and Recheck: Wait 15 minutes, then recheck your blood sugar.
Repeat if Necessary: If blood sugar is still low, repeat treatment.
Eat a Meal or Snack: Once blood sugar is stable, consume a longer-acting carbohydrate and protein source.
Identify the Cause: Understand why the low blood sugar event occurred.
Adjust Medication or Lifestyle: Modify your treatment plan or lifestyle as needed.
Seek Medical Advice: Consult with your healthcare provider if low blood sugar events are frequent or severe.

Step 1: Recognize the Symptoms of Low Blood Sugar

Being able to identify the symptoms of hypoglycemia is the first and perhaps most crucial step in managing a low blood sugar event. Symptoms can vary from person to person and can also change over time in the same individual.

Common Symptoms of Hypoglycemia:

Mild to Moderate Symptoms:
- Shakiness
- Sweating
- Dizziness or lightheadedness
- Hunger
- Irritability or anxiety
- Confusion
- Rapid heartbeat
- Blurry vision
- Headache
- Weakness or fatigue
Severe Symptoms:
- Inability to concentrate
- Loss of coordination
- Slurred speech
- Seizures
- Loss of consciousness

Example Scenario:

Imagine you're at work and suddenly feel shaky, sweaty, and lightheaded. You might also notice your heart is racing. These are classic symptoms of hypoglycemia, prompting you to move to the next step.

Important Considerations:

Hypoglycemia unawareness: Some individuals with diabetes may experience fewer or less noticeable warning signs of low blood sugar. This is known as hypoglycemia unawareness and can be dangerous. Regular blood sugar monitoring and consultation with a healthcare provider are essential.
Nocturnal hypoglycemia: Low blood sugar can also occur while you are sleeping (nocturnal hypoglycemia). Signs of this include damp sheets or nightclothes from sweating, nightmares, or waking up with a headache.

Factors Contributing to Varying Symptoms

| Factor | Impact | | -------------------- | -------------------------------------------------------------- | | Age | Children and the elderly may present different symptoms. | | Duration of Diabetes | Long-term diabetes can affect the body's response to low blood sugar. | | Medications | Some medications can mask or alter symptoms. | | Frequency of Events | Frequent hypoglycemia can lead to unawareness. |

Step 2: Check Your Blood Sugar Level Immediately

Once you recognize potential symptoms of low blood sugar, the next critical step is to confirm your suspicion with a blood glucose meter. This device measures the level of glucose in your blood and provides a definitive reading.

How to Check Your Blood Sugar:

Gather Supplies: You will need your blood glucose meter, a test strip, a lancing device, and an alcohol swab.
Wash Your Hands: Wash your hands thoroughly with soap and water. This helps prevent infection and ensures an accurate reading.
Prepare the Lancing Device: Insert a new lancet into the lancing device. Adjust the depth setting according to your skin type.
Insert Test Strip: Insert a compatible test strip into the blood glucose meter. Ensure the meter is turned on and ready for testing.
Prick Your Finger: Use the lancing device to prick the side of your fingertip.
Apply Blood to Test Strip: Gently squeeze your finger to obtain a small drop of blood. Touch the edge of the test strip to the blood drop, allowing the strip to draw in the required amount.
Wait for Results: The blood glucose meter will display your blood sugar level within a few seconds.
Record the Result: Write down the reading, along with the date and time. This will help you track patterns and share information with your healthcare provider.
Dispose of Supplies: Safely dispose of the used lancet in a sharps container and clean the meter as recommended by the manufacturer.

Interpreting Your Blood Sugar Reading:

Below 70 mg/dL (3.9 mmol/L): Indicates low blood sugar (hypoglycemia) requiring immediate treatment.
70-99 mg/dL (3.9-5.5 mmol/L): Within the normal range, but monitor for any symptoms.
100-125 mg/dL (5.6-6.9 mmol/L): Prediabetes range; consult your healthcare provider.
126 mg/dL (7.0 mmol/L) or higher: Indicates diabetes; requires further evaluation and management.

What if You Don't Have a Meter?

In situations where a blood glucose meter is not available, it is crucial to err on the side of caution and treat the symptoms as if they are due to low blood sugar. Consuming a fast-acting carbohydrate source will help raise blood sugar levels, and if the symptoms are not caused by hypoglycemia, it will not cause significant harm.

Accuracy Considerations:

Several factors can influence the accuracy of blood glucose readings, including:

Proper Calibration: Ensure your meter is calibrated correctly.
Expiration Dates: Check the expiration dates on test strips.
Storage Conditions: Store test strips and meter in a cool, dry place.
Hand Hygiene: Always wash your hands before testing.
Meter Maintenance: Follow the manufacturer's guidelines for meter maintenance and cleaning.

Step 3: Treat Low Blood Sugar Immediately with Fast-Acting Carbohydrates

Once you've confirmed that your blood sugar is low (below 70 mg/dL or 3.9 mmol/L), it's crucial to treat it immediately with a fast-acting carbohydrate source. These are foods or drinks that are quickly absorbed into the bloodstream, raising your blood sugar level rapidly.

The "15-15 Rule":

The standard approach to treating hypoglycemia involves the "15-15 rule":

Consume 15 grams of fast-acting carbohydrates.
Wait 15 minutes.
Recheck your blood sugar.
If your blood sugar is still below 70 mg/dL, repeat steps 1-3.

Examples of 15 Grams of Fast-Acting Carbohydrates:

Glucose Tablets: 3-4 glucose tablets (check the label for carbohydrate content)
Glucose Gel: 1 tube of glucose gel (check the label)
Fruit Juice: 4 ounces (120 ml) of regular (non-diet) fruit juice
Regular Soda: 4 ounces (120 ml) of regular (non-diet) soda
Hard Candies: 3-4 hard candies (check the label, and avoid sugar-free options)
Honey or Sugar: 1 tablespoon of honey or table sugar

Important Considerations:

Avoid Fatty Foods: Do not use foods high in fat, such as chocolate bars or peanut butter, to treat low blood sugar. Fat slows down the absorption of glucose, delaying the rise in blood sugar levels.
Read Labels Carefully: Always check the nutritional information on food labels to ensure you are consuming the correct amount of carbohydrates.
Keep a Supply on Hand: Carry a supply of fast-acting carbohydrates with you at all times, especially when exercising, traveling, or engaging in activities that may increase the risk of hypoglycemia.
Consider Liquid Forms: Liquid carbohydrates, like juice or soda, tend to be absorbed more quickly than solid foods.

Scenario Example:

Let's say your blood sugar is 65 mg/dL. You decide to drink 4 ounces of regular fruit juice. After consuming the juice, you set a timer for 15 minutes before rechecking your blood sugar.

List of Ideal and Non-Ideal Choices

| Ideal Choices (15g Carbs) | Non-Ideal Choices (Too Slow) | | ------------------------------------ | -------------------------------- | | 3-4 Glucose Tablets | Chocolate Bar | | 4 oz Fruit Juice | Peanut Butter | | 4 oz Regular Soda | Whole Grain Crackers | | 1 Tablespoon Honey/Sugar | Diet Soda |

Step 4: Wait 15 Minutes and Recheck Your Blood Sugar

After consuming 15 grams of fast-acting carbohydrates, it’s crucial to wait for 15 minutes before rechecking your blood sugar. This waiting period allows the carbohydrates to be absorbed into your bloodstream and begin raising your blood glucose levels. Resist the urge to eat more immediately, as overeating can lead to hyperglycemia (high blood sugar).

Why 15 Minutes?

The 15-minute interval is based on the typical absorption rate of fast-acting carbohydrates. It gives the body enough time to process the glucose and show a measurable increase in blood sugar. Checking too soon may give a false reading, leading to unnecessary additional carbohydrate intake.

How to Recheck Your Blood Sugar:

Set a Timer: Immediately after consuming your chosen carbohydrate source, set a timer for 15 minutes.
Avoid Further Food or Drink: During this 15-minute waiting period, avoid consuming any additional food or drink, as this could interfere with the accuracy of your blood sugar reading.
Recheck with Your Meter: After 15 minutes, use your blood glucose meter to recheck your blood sugar level, following the same procedure as outlined in Step 2.

Interpreting the Results After 15 Minutes:

Blood Sugar 70 mg/dL (3.9 mmol/L) or Higher: If your blood sugar has risen to 70 mg/dL or higher, and you are feeling better, proceed to Step 6 and consume a more substantial meal or snack to stabilize your blood sugar.
Blood Sugar Still Below 70 mg/dL (3.9 mmol/L): If your blood sugar is still below 70 mg/dL, proceed to Step 5 and repeat the treatment process by consuming another 15 grams of fast-acting carbohydrates.

Important Note:

If, after the initial treatment and waiting period, you still feel symptomatic despite your blood sugar being above 70 mg/dL, it is possible that your body is just taking longer to recover from the low. Monitor your symptoms closely and, if necessary, consult your healthcare provider.

Example Scenario:

You've waited 15 minutes after drinking 4 ounces of fruit juice. You recheck your blood sugar, and it's now 75 mg/dL. You are feeling better. It's time for a more substantial snack to prevent another drop.

Step 5: Repeat Treatment If Necessary

If, after following the 15-15 rule (consuming 15 grams of fast-acting carbohydrates and waiting 15 minutes), your blood sugar is still below 70 mg/dL (3.9 mmol/L), it’s essential to repeat the treatment process. This means consuming another 15 grams of fast-acting carbohydrates and waiting another 15 minutes before rechecking your blood sugar.

When to Repeat Treatment:

Blood Sugar Remains Low: If your blood glucose level remains below 70 mg/dL after the initial 15-minute waiting period, repeat the treatment process immediately.
Symptoms Persist: Even if your blood sugar has risen slightly but you are still experiencing symptoms of hypoglycemia, it is prudent to repeat the treatment, as some individuals may require a higher blood sugar level to feel completely symptom-free.

How to Repeat Treatment:

Consume Another 15 Grams of Fast-Acting Carbohydrates: Choose another source of fast-acting carbohydrates from the list provided in Step 3. Ensure you consume the correct amount to provide 15 grams of carbohydrates.
Wait Another 15 Minutes: After consuming the second dose of carbohydrates, set a timer for another 15 minutes. Avoid consuming any additional food or drink during this period.
Recheck Your Blood Sugar: After the second 15-minute waiting period, use your blood glucose meter to recheck your blood sugar level.

Example Scenario:

After the first 15-minute interval, your blood sugar is still at 68 mg/dL. You decide to take 3 glucose tablets (each containing 5 grams of carbohydrates). You wait another 15 minutes and then recheck.

Important Considerations During Repeated Treatments

| Consideration | Explanation | | ---------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | Avoid Overcorrection | Be careful not to overcorrect by consuming too much carbohydrate at once. Overcorrection can lead to hyperglycemia (high blood sugar), which can also be detrimental to your health. | | Monitor Symptoms Closely | Pay close attention to how you are feeling during each waiting period. Note any changes in your symptoms, whether they are improving, worsening, or remaining the same. | | Seek Assistance If Needed | If you are unable to treat your low blood sugar effectively on your own, or if you experience severe symptoms such as confusion, seizures, or loss of consciousness, seek immediate medical assistance. |

Step 6: Eat a Meal or Snack with Protein and Complex Carbohydrates

Once your blood sugar has risen above 70 mg/dL (3.9 mmol/L) and you're feeling better, it's vital to consume a meal or snack that contains both protein and complex carbohydrates. This will help stabilize your blood sugar levels and prevent another hypoglycemic episode. The goal is to provide a sustained release of glucose into the bloodstream, avoiding a rapid drop.

Why Protein and Complex Carbohydrates?

Complex Carbohydrates: Unlike simple sugars, complex carbohydrates are digested more slowly, providing a gradual and sustained release of glucose into the bloodstream. This helps prevent blood sugar levels from dropping too quickly. Examples include whole grains, legumes, and non-starchy vegetables.
Protein: Protein also helps stabilize blood sugar levels by slowing down the absorption of carbohydrates. Additionally, protein provides essential amino acids that support overall health. Examples include lean meats, poultry, fish, eggs, dairy products, and nuts.

Examples of Balanced Meals or Snacks:

Whole-Grain Toast with Peanut Butter: Whole-grain toast provides complex carbohydrates, while peanut butter offers protein and healthy fats.
Apple Slices with Cheese: Apple slices provide fiber and carbohydrates, while cheese offers protein and calcium.
Greek Yogurt with Berries and Nuts: Greek yogurt is rich in protein, berries provide antioxidants and fiber, and nuts contribute healthy fats and protein.
Small Sandwich on Whole-Grain Bread: Use lean meats like turkey or chicken with lettuce and tomato on whole-grain bread for a balanced combination.
A Handful of Trail Mix: Choose a trail mix that contains a mix of nuts, seeds, and dried fruit for a balance of protein, healthy fats, and complex carbohydrates.

Timing is Key:

Consume your balanced meal or snack within one hour of treating the low blood sugar event. This helps prevent blood sugar levels from dropping again while your body adjusts.

Why Some Foods Are Better Than Others

| Food Group | Benefits | Examples | | -------------------- | --------------------------------------------------------- | ------------------------------------------------------------------------- | | Whole Grains | Slow release of glucose, prevents rapid drops | Whole-grain bread, brown rice, oatmeal | | Lean Proteins | Stabilizes blood sugar, provides essential amino acids | Chicken, turkey, fish, tofu | | Healthy Fats | Enhances satiety, helps stabilize blood sugar | Avocado, nuts, seeds, olive oil | | Non-Starchy Veggies | Provides fiber and nutrients without significant carbs | Broccoli, spinach, bell peppers |

Step 7: Identify the Cause of the Low Blood Sugar Event

After successfully treating a low blood sugar event and stabilizing your blood sugar levels, it is essential to identify the underlying cause of the episode. Understanding why your blood sugar dropped too low can help you prevent future occurrences and better manage your diabetes. The Complete Guide To Lowering Your Fasting Blood Sugar

Common Causes of Low Blood Sugar:

Excess Insulin: Taking too much insulin is one of the most common causes of hypoglycemia, especially in people with type 1 diabetes. This can occur if you miscalculate your insulin dose, inject the wrong type of insulin, or take insulin at the wrong time.
Missed or Delayed Meals: Skipping meals or delaying eating can lead to low blood sugar, as your body does not have enough glucose to fuel itself. This is particularly important for individuals who take insulin or other diabetes medications.
Inadequate Carbohydrate Intake: Not eating enough carbohydrates can also cause hypoglycemia. Carbohydrates are the body's primary source of glucose, so insufficient intake can lead to low blood sugar levels.
Increased Physical Activity: Exercise can lower blood sugar levels, especially if you are not properly prepared. Physical activity increases the body's demand for glucose, and if you do not consume enough carbohydrates before, during, or after exercise, you may experience hypoglycemia.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, leading to low blood sugar. This effect is more pronounced when alcohol is consumed on an empty stomach.
Certain Medications: Some medications, such as sulfonylureas, can increase insulin secretion and lead to hypoglycemia. Additionally, certain non-diabetes medications can also affect blood sugar levels.
Kidney or Liver Problems: Kidney and liver problems can impair the body's ability to regulate blood sugar levels, increasing the risk of hypoglycemia.
Hormonal Imbalances: Certain hormonal disorders can affect glucose metabolism and lead to low blood sugar.

Questions to Ask Yourself:

To identify the cause of your low blood sugar event, consider the following questions:

Did I take my insulin or other diabetes medications as prescribed?
Did I eat my meals on time and consume an adequate amount of carbohydrates?
Did I engage in any physical activity or exercise that I was not prepared for?
Did I consume alcohol, and if so, how much and when?
Have I recently changed any of my medications or experienced any changes in my health?

Tracking Your Blood Sugar:

Keeping a detailed record of your blood sugar levels, along with information about your meals, medications, activity levels, and other relevant factors, can help you identify patterns and pinpoint the cause of your low blood sugar events.

Key Factors for Cause Analysis

| Factor | Details to Consider | | ---------------- | --------------------------------------------------------------------------------- | | Medication | Dosage, timing, type of medication, recent changes | | Diet | Meal timing, carbohydrate content, missed meals, changes in dietary habits | | Activity | Intensity, duration, timing in relation to meals and medication, preparation | | Alcohol | Amount consumed, consumed with or without food, timing in relation to medication | Understanding Your A1C Test What Your Hba1C Results Really Mean

Step 8: Adjust Medication or Lifestyle as Needed

Based on the identified cause of your low blood sugar event, the next step is to adjust your medication or lifestyle as needed. These adjustments are crucial for preventing future episodes of hypoglycemia and maintaining stable blood sugar levels.

Possible Adjustments:

Medication Adjustments:
- Insulin Dose: If excess insulin was the cause, your healthcare provider may recommend reducing your insulin dose, especially if you have type 1 diabetes.
- Timing of Insulin: Adjusting the timing of your insulin injections to better match your meal schedule can also help prevent hypoglycemia.
- Medication Changes: If other diabetes medications, such as sulfonylureas, are contributing to low blood sugar, your healthcare provider may consider switching to a different medication.
Lifestyle Adjustments:
- Meal Timing and Content: Eating meals and snacks on a regular schedule and ensuring they contain an adequate amount of carbohydrates can help prevent hypoglycemia.
- Carbohydrate Intake: Increasing your carbohydrate intake, especially before exercise or other physical activity, can also help stabilize blood sugar levels.
- Exercise Planning: If exercise is a trigger for hypoglycemia, plan ahead by consuming a carbohydrate-rich snack before, during, or after exercise. Monitor your blood sugar levels closely during exercise and adjust your insulin dose or carbohydrate intake as needed.
- Alcohol Consumption: Limit your alcohol intake and always consume alcohol with food to prevent hypoglycemia.
Preventative Measures:
- Frequent Blood Sugar Monitoring: Regularly check your blood sugar levels, especially before meals, after meals, before exercise, and before bedtime. This can help you identify patterns and prevent low blood sugar events.
- Carry Fast-Acting Carbohydrates: Always carry a supply of fast-acting carbohydrates with you, such as glucose tablets or fruit juice, so you can treat low blood sugar quickly if it occurs.
- Wear a Medical Alert ID: Consider wearing a medical alert ID that indicates you have diabetes. This can help ensure that you receive appropriate medical attention if you experience severe hypoglycemia and are unable to communicate.

Working with Your Healthcare Provider:

It is essential to work closely with your healthcare provider when making any adjustments to your medication or lifestyle. Your healthcare provider can provide personalized guidance based on your individual needs and help you develop a comprehensive diabetes management plan.

Actionable Adjustment Examples

| Cause | Adjustment | | --------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------ | | Insulin Overdose | Consult doctor for dosage adjustment; consider using insulin pens for more precise dosing. | | Skipped Meal | Set reminders to eat meals on time; keep portable snacks on hand. | | Intense Exercise | Consume a carbohydrate-rich snack before exercising; monitor blood sugar during exercise. | | Alcohol on Empty Stomach | Always consume alcohol with food; limit alcohol intake. |

Step 9: Seek Medical Advice If Low Blood Sugar Events are Frequent or Severe

While occasional episodes of mild hypoglycemia can often be managed at home, it is essential to seek medical advice if low blood sugar events are frequent or severe. Frequent or severe hypoglycemia can indicate underlying issues with your diabetes management plan and may require adjustments to your medication or lifestyle.

When to Seek Medical Advice:

Frequent Hypoglycemia: If you experience low blood sugar events more than once or twice a week, despite following your diabetes management plan, consult your healthcare provider.
Severe Hypoglycemia: If you experience severe hypoglycemia that requires assistance from others, such as glucagon administration or emergency medical attention, seek immediate medical advice.
Hypoglycemia Unawareness: If you have difficulty recognizing the symptoms of low blood sugar (hypoglycemia unawareness), consult your healthcare provider. This can be a dangerous condition that requires careful management.
Nocturnal Hypoglycemia: If you suspect you are experiencing low blood sugar while sleeping (nocturnal hypoglycemia), consult your healthcare provider. Nocturnal hypoglycemia can be difficult to detect and may require adjustments to your medication or lifestyle.
Unexplained Hypoglycemia: If you experience low blood sugar events for no apparent reason, despite following your diabetes management plan, consult your healthcare provider to rule out any underlying medical conditions.

What to Expect During a Medical Consultation:

During a medical consultation for frequent or severe hypoglycemia, your healthcare provider may:

Review Your Medical History: Your healthcare provider will review your medical history, including your diabetes diagnosis, medications, and any other relevant medical conditions.
Assess Your Diabetes Management Plan: Your healthcare provider will assess your current diabetes management plan, including your insulin or medication doses, meal schedule, and exercise routine.
Perform a Physical Examination: Your healthcare provider may perform a physical examination to check for any signs of underlying medical conditions.
Order Blood Tests: Your healthcare provider may order blood tests to check your blood sugar levels, kidney function, liver function, and hormone levels.
Adjust Your Treatment Plan: Based on the results of the evaluation, your healthcare provider may recommend adjustments to your medication doses, meal schedule, or exercise routine.

Continuous Glucose Monitoring (CGM):

In some cases, your healthcare provider may recommend using a continuous glucose monitor (CGM) to track your blood sugar levels in real time. A CGM can provide valuable information about your blood sugar patterns and help you identify potential triggers for hypoglycemia.

Benefits of Seeking Professional Advice

| Benefit | Explanation | | --------------------------------- | ------------------------------------------------------------------------------------------------------------------------- | | Personalized Management | Tailored adjustments to your treatment plan based on your individual needs and circumstances. | | Identification of Underlying Issues | Ruling out any potential medical conditions or medication interactions contributing to hypoglycemia. | | Education and Support | Gaining a better understanding of diabetes management and receiving ongoing support from healthcare professionals. |

By following this step-by-step guide and seeking medical advice when needed, you can effectively manage low blood sugar events and maintain optimal health and well-being with diabetes. Being proactive and informed is key to staying safe and living a full, active life. A Practical Guide To Creating And Using A Blood Sugar Chart