Treatment of Hypoglycemia

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Hypoglycemia (low blood sugar, insulin reaction) is most likely to occur before meals, at peak times of insulin action, and during or after exercise.

Symptoms of mild hypoglycemia (blood glucose usually 50-70 mg/dl):

  • Shaky
  • Irritable
  • Sweaty
  • Clumsy
  • Pale
  • Nervous
  • Weak
  • Hungry
  • Tingling lips

Symptoms of moderate hypoglycemia (blood glucose usually less than 50 mg/dl)
- In addition to symptoms of mild hypoglycemia:

  • Confused
  • Restless
  • Headache
  • Poor coordination
  • Double vision

Symptoms of advanced hypoglycemia
- In addition to previous symptoms:

  • Unconscious
  • Convulsions

Test to confirm hypoglycemia

If the blood sugar is greater than 80 mg/dl, you are not having symptoms of hypoglycemia.

Treatment-Quick Sugar: 15 g Carbohydrate

  • Glucose tablets (check carbohydrate content)
  • 1/2 cup juice
  • 1/2 cup regular soda
  • 4 sugar cubes
  • 15 g Glucose gel

Do not subtract food from next meal!

Treatment-Quick Sugar: 30 g Carbohydrate

  • Glucose tablets (check carbohydrate content)
  • 1 cup juice
  • 1 cup regular soda
  • 8 sugar cubes
  • 30 g Glucose gel

Do not subtract food from next meal!


  • First, call 911.
  • Glucagon is kept in the fridge. We do not give glucagon to all, so there may not be any.
  • The instructions are with the glucagon.
  • If you do not have glucagon, turn the person onto their side and use 2 tablespoons of honey on the inside of the cheek.
  • Do not try sweet drinks due to risk of inhaling a liquid when unconscious.
  • When the person comes to, feed them a sugared beverage (2 cups of juice or regular soda) followed by 60 g of "slower" carbohydrate (bread, fruit, crackers) + meat or cheese + fat.

Test your blood sugar after 15 minutes. If the blood sugar doesn't rise, repeat the treatment, wait 15 minutes again and re-test. If the blood sugar still does not rise above 70 mg/dl, repeat the treatment but also notify your physician.

If you have had a severe low blood sugar, allow your blood sugars to run higher for the next 24-48 hours as there is a higher risk of another low blood sugar. One way to do this is to raise your goal range by 40 mg/dl.

Once you have corrected the blood sugar to above 70 mg/dl AND if you will not be eating a meal within 1 hour, eat a combination of protein, fat and carbohydrate - for instance, 3 peanut butter crackers or 1/2 a sandwich, to help maintain the blood sugar until your next meal.

Note: As everything else in diabetes, the above treatment may need to vary based on individual experience.

Driving: If you feel the symptoms of hypoglycemia while driving, STOP THERE (not the next exit, etc.). Do not start driving again until you have treated yourself, feel better and have confirmed that your blood sugar is back up. If you have nothing to eat in the car to treat hypoglycemia, knock on a door, flag down a car, etc., but do not drive on. Always carry fast acting glucose in the car. Driving even another 100 feet while you are hypoglycemic could cause an accident.

Anger during low blood sugar*

During hypoglycemia, the ability to think or reason may become impaired because the brain can only use glucose as fuel. Confusion and irrational behavior can result. Reactions to this "lack of fuel" can vary tremendously and anger is a common response. It helps to treat hypoglycemia quicky.

For the helper
Generally, a person having a hypoglycemic reaction will not need help. If a person having low blood sugar becomes angry, confused or irrational, try the steps below:

  1. Take charge of the situation. Be gentle but firm.
  2. Control your own emotions. Don't take the other person's behavior personally.
  3. Say, "Here, eat these glucose tablets" or "Drink some of this drink" or "You need to eat/drink this."
  4. Avoid indirect questions like, "Do you need to test?" or "Do you need to eat?" If a person's blood sugar is low, the easiest answer during the confusion may be "No."
  5. Do NOT let the person drive a car, run machinery or participate in any other dangerous activity that requires coordination.
  6. Ask for help from others whenever needed.
  7. Stay rational and calm. This will minimize embarrassment to the person with diabetes.
  8. If you feel that you cannot handle the situation, call 911.

*adapted from Anger during Low Blood Sugars by John Walsh, PA, CDE, and Ruth Roberts.