What to Do When Your Blood Sugar is Low: A Step-by-Step Plan

18 Sep 2025 By Brandon P. Verdoorn, M.D.

What to Do When Your Blood Sugar is Low: A Step-by-Step Plan

Hypoglycemia, or low blood sugar, can be a frightening experience, especially for individuals managing diabetes. Recognizing the symptoms and knowing how to react quickly and effectively is crucial. This article offers a detailed, step-by-step plan for managing low blood sugar, ensuring you're prepared to handle such situations with confidence. Whether you're newly diagnosed or a seasoned pro at managing your blood sugar, understanding these steps can be life-saving.

Why Understanding Low Blood Sugar Is Important

Low blood sugar can occur for various reasons, including:

Taking too much insulin or other diabetes medications.
Skipping meals or not eating enough carbohydrates.
Increased physical activity.
Drinking alcohol.

Ignoring low blood sugar can lead to severe consequences, such as seizures, loss of consciousness, and even death. Therefore, immediate action is essential. Recognizing Severe Hypoglycemia When To Seek Immediate Medical Help

| Symptom | Description | | ------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Shakiness | Feeling unsteady or trembling. | | Sweating | Profuse sweating, often unrelated to physical activity or temperature. | | Dizziness or Lightheadedness | A sensation of spinning or feeling faint. | | Confusion or Difficulty Concentrating | Trouble thinking clearly or focusing on tasks. | | Irritability or Mood Changes | Feeling anxious, short-tempered, or unusually emotional. | | Rapid Heartbeat | An increased heart rate, sometimes noticeable as palpitations. | | Blurred Vision | Difficulty seeing clearly. | | Headache | A mild to severe headache. | | Hunger | An intense feeling of needing to eat immediately. |

Step 1: Recognize the Symptoms Quickly

The first and most critical step is to recognize the symptoms of low blood sugar. These symptoms can vary from person to person and can sometimes mimic other conditions. Common symptoms include:

Shakiness: Feeling unsteady or trembling.
Sweating: Unexplained or excessive sweating.
Dizziness: Feeling lightheaded or faint.
Confusion: Difficulty concentrating or thinking clearly.
Irritability: Feeling anxious or easily agitated.
Rapid heartbeat: A noticeable increase in heart rate.
Blurred vision: Difficulty seeing clearly.
Headache: A mild to severe headache.
Hunger: A strong, sudden urge to eat.

It's essential to monitor your blood sugar regularly, especially if you're prone to hypoglycemia. This proactive approach can help you catch low blood sugar episodes early and take prompt action. For continuous monitoring, consider using a continuous glucose monitor (CGM), which tracks your blood sugar levels in real-time. Mastering Type 2 Diabetes A Beginner S Guide To Blood Sugar Control

Example: Recognizing Symptoms in Real Life

Imagine Sarah, who has type 1 diabetes. During her afternoon walk, she starts feeling shaky and unusually sweaty. Remembering her doctor's advice, she immediately recognizes these as potential symptoms of low blood sugar. This quick recognition is the first step in preventing a more severe episode.

Step 2: Check Your Blood Sugar Levels Immediately

Once you suspect low blood sugar, check your blood glucose level immediately using a glucose meter. This confirms whether you're experiencing hypoglycemia. Glycemic Index Vs Glycemic Load A Guide For Better Blood Sugar Control

Aim for a Target: Generally, a blood sugar level below 70 mg/dL (3.9 mmol/L) is considered low.
Use a Reliable Meter: Ensure your glucose meter is properly calibrated and that you're using fresh test strips.

Using a Continuous Glucose Monitor (CGM)

If you use a CGM, check your device to see your current glucose reading and trend. A CGM can provide early warnings about falling blood sugar levels, allowing you to take action before symptoms become severe.

| Scenario | Action | | --------------- | ------------------------------------------------------------------------ | | Meter Reading | Follow the 15-15 rule (explained in the next step). | | CGM Alert | Verify the CGM reading with a fingerstick test if you're unsure. |

Example: Validating with a Glucose Meter

After noticing her symptoms, Sarah immediately stops her walk and uses her glucose meter. The reading shows 65 mg/dL. Confirming the low reading is crucial before taking any corrective action.

Step 3: Apply the 15-15 Rule

The 15-15 rule is a cornerstone of managing low blood sugar:

Consume 15 grams of fast-acting carbohydrates: This will quickly raise your blood sugar level.
Wait 15 minutes: Allow the carbohydrates to be absorbed into your bloodstream.
Recheck your blood sugar: If your blood sugar is still below 70 mg/dL, repeat the process.

Suitable Sources of 15 Grams of Fast-Acting Carbs:

Glucose tablets: These are specifically designed to raise blood sugar quickly.
Glucose gel: Similar to tablets, but in gel form.
4 ounces (120 ml) of fruit juice: Orange, apple, or grape juice.
4 ounces (120 ml) of regular (non-diet) soda: Avoid diet sodas as they don't contain sugar.
1 tablespoon of honey or sugar.
Hard candies (check label): About 3-4 pieces, but absorption may be slower.

Example: Implementing the 15-15 Rule

Sarah eats four glucose tablets, each containing 4 grams of carbohydrates, totaling 16 grams. She sets a timer for 15 minutes. After the timer goes off, she rechecks her blood sugar.

| Time (Minutes) | Action | Blood Sugar (mg/dL) | | :------------- | :-------------------------- | :------------------ | | 0 | Initial Check & Consumption | 65 | | 15 | Recheck | 85 |

In this example, Sarah's blood sugar rises to 85 mg/dL, indicating the 15-15 rule was effective.

Step 4: When to Seek Emergency Assistance

While most episodes of low blood sugar can be managed at home, some situations require immediate medical attention. Seek emergency assistance if:

You are unable to treat the low blood sugar yourself: This could be due to confusion or inability to swallow.
You lose consciousness: If you pass out, someone needs to administer glucagon or call emergency services.
You have a seizure: Seizures can occur during severe hypoglycemia.
Your blood sugar does not rise after multiple attempts to treat it: If you've followed the 15-15 rule several times and your blood sugar remains low, it's crucial to get help.

Glucagon: A Lifesaving Treatment

Glucagon is a hormone that raises blood sugar levels quickly. It is available as an injectable medication or nasal spray and is prescribed for individuals at risk of severe hypoglycemia. Family members, friends, or caregivers should be trained on how to administer glucagon in case of an emergency.

Steps for Using Glucagon:

Check the expiration date: Ensure the glucagon is not expired.
Prepare the injection: Follow the instructions provided with the glucagon kit to mix and prepare the injection.
Administer the injection: Inject into the thigh or arm muscle.
Call for emergency assistance: After administering glucagon, call 911 or your local emergency number.

Example: Emergency Scenario

John, who has type 2 diabetes, becomes unresponsive at home. His wife, Mary, recognizes he is likely experiencing severe hypoglycemia. She quickly administers a glucagon injection and immediately calls 911. The paramedics arrive and provide further medical assistance.

Step 5: Follow-Up with a Longer-Acting Carbohydrate Source

After your blood sugar has returned to a safe level, consume a longer-acting carbohydrate source to prevent another drop. This will provide a sustained release of glucose into your bloodstream.

Examples of Longer-Acting Carbohydrate Sources:

A small sandwich: Whole-grain bread with lean protein.
A piece of fruit and a handful of nuts.
A cup of yogurt.
A small serving of oatmeal.

Importance of Protein and Fat

Adding a small amount of protein or healthy fats to your snack can help stabilize your blood sugar levels even further.

Example: Sustaining Blood Sugar Levels

After treating her low blood sugar, Sarah eats a small apple with a tablespoon of peanut butter. The apple provides carbohydrates, while the peanut butter offers protein and fat to keep her blood sugar stable for the next few hours.

Step 6: Investigate the Cause and Prevent Future Episodes

Once you've addressed the immediate episode of low blood sugar, it's essential to investigate the cause and take steps to prevent future occurrences.

Questions to Ask Yourself:

Did I skip a meal or snack?
Did I take too much medication?
Was I more active than usual?
Did I drink alcohol?
Have there been any recent changes in my medication or routine?

Tips for Preventing Low Blood Sugar:

Follow a consistent meal schedule: Eat meals and snacks at regular times each day.
Monitor your blood sugar regularly: Keep track of your blood sugar levels to identify patterns and trends.
Adjust your medication as needed: Work with your healthcare provider to adjust your medication dosage based on your blood sugar levels and activity levels.
Carry a source of fast-acting carbohydrates with you at all times: Be prepared for low blood sugar episodes, no matter where you are.
Inform your family, friends, and coworkers about your condition: Make sure they know how to recognize the symptoms of low blood sugar and how to help you if you need assistance.
Consider wearing a medical identification bracelet or necklace: This can alert emergency responders to your condition if you are unable to communicate.

Example: Identifying and Addressing the Root Cause

After experiencing her low blood sugar episode, Sarah realizes she had skipped her usual afternoon snack. She resolves to set a reminder on her phone to ensure she never misses a snack again. She also discusses this incident with her doctor during her next appointment, who adjusts her insulin dosage slightly to prevent future lows.

Conclusion: Empowering Yourself to Manage Low Blood Sugar

Managing low blood sugar effectively requires a combination of awareness, preparation, and prompt action. By following this step-by-step plan, you can confidently handle episodes of hypoglycemia and maintain stable blood sugar levels.

Key Takeaways:

Recognize the symptoms of low blood sugar quickly.
Check your blood sugar levels immediately with a glucose meter.
Apply the 15-15 rule to raise your blood sugar.
Seek emergency assistance when necessary, and use glucagon if available.
Follow-up with a longer-acting carbohydrate source to prevent another drop.
Investigate the cause and take steps to prevent future episodes.

Empower yourself with knowledge and the right tools, and always consult with your healthcare provider for personalized advice on managing your blood sugar.