Practice the Rule of 15: If you experience symptoms of hypoglycemia or your meter detects low blood glucose:
• Eat 15 grams of carbohydrate, such as four glucose tablets, a small orange or apple, 8 ounces of fat-free milk, or a 6-ounce container of low-fat yogurt.
• Recheck your blood sugar in 15 minutes.
• Eat another 15 grams of carbohydrate if your blood sugar hasn't risen to at least the low end of your target range.
Why 15 grams of carbohydrate? "Fifteen grams of carbs is a good starting point," says Karen Bolderman, R.D., CDE, who has type 1 diabetes. Eating more than 15 grams can cause blood glucose to jump too high. "Then it's difficult to get your glucose back down, plus you've eaten a lot of unwanted calories, which can pack on the pounds," she says.
Eat the "right" carbs: Choose pure glucose in the form of tablets, a liquid, or a gel to get the most efficient supply of glucose -- and not the extra calories from fat or protein. Bolderman also suggests that if pure glucose is not available, fat-free milk, jelly beans, or dried or fresh fruit work well, too. Fruit juice is a popular option, but the fructose in juice doesn't raise blood sugar as effectively as sources of pure glucose, such as tablets or gel.
Avoid treating low blood sugar with foods that are high in protein or fat, such as peanut butter, cheese, or chocolate. You may hear people say you need to eat some protein along with a carbohydrate-containing food; however, that’s no longer the recommendation because it hasn't been shown to prevent future lows. Additionally, fat can actually prolong hypoglycemia because it might slow the rise of glucose.
Don't skip meals: If you do, eat a piece of fruit, yogurt, nutrition bar, or other healthful snack to replace the missing carbohydrate. Adjust your blood glucose-lowering medication as advised by your health care provider.
Don't delay meals: If you do, snack on a food that contains carbohydrate, or delay taking your blood glucose-lowering medication as suggested by your health care provider.
Adjust for your activity level: On active days, learn how you can decrease your blood glucose-lowering medication, if need be, as recommended by your health care provider.
Be vigilant about alcohol: If you drink alcohol, check your blood sugar more often. Alcohol can cause low blood sugar from a few hours to many hours after you drink if you take one or more medications that can cause hypoglycemia.
Prepare for Rare Severe Hypoglycemia
Although severe hypoglycemia is exceedingly unlikely, especially as you become more skilled at identifying and treating mild hypoglycemia, it does occur from time to time. To set your mind at ease, make sure you:
• Talk to your health care provider about prescribing glucagon if you take insulin. Have a glucagon emergency kit in places where you spend a lot of time -- home, work, or the school health office. About twice a year, check the expiration date on your glucagon kit. Glucagon must be injected by someone else to treat an unconscious hypoglycemic reaction.
• Wear recognizable medical identification to let people know you have diabetes. This is essential for emergency personnel to provide proper care, particularly if you are unconscious.
Feel Confident, Not Afraid
Worrying about hypoglycemia will only promote stress. Stay healthy by keeping your blood sugar in your target range. Occasionally, when you think you're going too low, try guessing your blood glucose and check your accuracy with your meter. This helps you gain confidence by knowing you can detect and treat low blood sugar levels. Make it a habit to carry your diabetes supplies with you, and be prepared to treat low blood glucose no matter where you are.
Experiment safely to find the hypoglycemia treatment that works best for you. If you experience the telltale signs of hypoglycemia, act quickly to offset progression to a severe low. It's a good idea to let friends, family, coaches, teammates, and coworkers know how they can help if you go low and can't help yourself. Encourage them to call 911 if they need help.
If you are experiencing hypoglycemia regularly (such as a few times a week), tell your health care provider. It's likely that you need to adjust your diabetes management plan.
Remember: If your blood sugar is low before you plan to drive, treat yourself and check again before you get behind the wheel. Make sure you're back to target range before starting the vehicle.
Hope Warshaw, R.D., CDE, is a contributing editor to Diabetic Living and author of Diabetes Meal Planning Made Easy, fourth edition (American Diabetes Association, 2010).