Low Blood Sugar
(Written by Shirley Powell, PA-C)
What is Low Blood Glucose?
Low blood glucose (or hypoglycemia or insulin reaction) is when the blood glucose goes
below 70 mg/dl. Symptoms may occur if the blood glucose is dropping quickly even
though they may be in your target range. Hypoglycemia occurs when the body does not
have enough glucose for energy. Untreated severe low blood glucose may be very
serious.
Causes of low blood glucose
 Meals or snacks that are late or missed
 Extra exercise that used more glucose than usual
 An insulin or oral medication dose that is too high
 An insulin dose peaking at a different time than usual
 Giving an injection into the muscle (increases the absorption of insulin)
 Making a mistake with drawing up the insulin with the wrong dose or the wrong
insulin
 Taking a bath or shower (or hot tub) after taking an injection or bolus of insulin.
(Wait 90 minutes)
 Drinking alcohol without eating
Symptoms of low blood glucose (hypoglycemia)
Mild Hypoglycemia
 Shakiness
 Nervousness
 Sweating
 Dizziness
 Fast heart beat
 Hungry
 Tiredness, Fatigue
 Weak
 Pale
 Numbness or tingling
mouth or lips
Moderate Hypoglycemia
 Headache
 Personality change
 Lack of focus
 Confused
 Disoriented
 Out of control
 Poor coordination
 Slurred or slow
speech
 Blurred vision
Severe Hypoglycemia
 Loss of
consciousness
 Seizure
Helpful guidelines
 Always carry hypoglycemia treatment food with you
 Check you blood glucose before, during and after physical activity
 Check you blood glucose before you drive or use heavy equipment
 Wear identification such as a bracelet, stating that you have diabetes
 Teach family, friends, coworkers to recognize the symptoms and treatments of
low blood glucose
 Teach family, friends and coworkers how to use glucagon in an emergency.
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Treatment of low blood sugar (hypoglycemia)

15-15 Rule
o Check blood glucose level
o Give 15 grams of glucose or simple carbohydrate (sugary)
 3 glucose tablets
 ½ of 1 tube instant glucose (1 tube equals 31 grams CHO)
 1 small tube of cake gel (equals 12 grams CHO)
 4 ounces of juice
 ½ cup of regular soft drink
 10 oz glass of milk
 6-7 jellybeans
 6 Life savers
 15 Skittles
 8 pieces of Sweet Tarts
 3 teaspoons sugar or honey
o Rest for 15 minutes
o Recheck blood glucose in 15 minutes (10-20 minutes)
o If blood glucose is less than 70 mg/dl (or 80 mg/dl for some people)
repeat the treatment of 15 gm carbohydrate of sugary food, repeat rest
and repeat monitoring blood glucose
o If blood glucose is greater than 70 mg/dl (or 80 mg/dl for some people)
eat a solid snack

Other considerations for treatment of hypoglycemia
o If a severe hypoglycemia reaction is occurring or the individual is
unconscious or having a seizure place individual in a safe position and
treat with glucagon.
o Report severe low blood glucose events to the physician, physician
assistant, or nurse
o Evaluate any cause for the low blood glucose.
o Carefully evaluate night time hypoglycemia
 Consider post exercise hypoglycemia
 Consider Insulin action
 Know the different symptoms such as nightmares, night sweats,
seizures and morning headaches
o Do not eat candy bars or chocolate because the fat in these foods slow
the rise of the blood sugar.
o Do not eat a snack until the blood sugar has returned to greater than 80
mg/dl because the fat and protein will slow the rise in blood glucose
o For children adjust the portion of the simple carbohydrates for age such
as give a 2 year old 2 ounces of juice
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