Managing a Hypoglycemic Episode

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People with diabetes are constantly watching their blood sugar for dips and spikes. Diabetes treatment and other factors, like not eating enough carbohydrates, can contribute to a drop in blood sugar (glucose) levels. When your blood sugar is too low, it’s called hypoglycemia.

You have hypoglycemia if your blood sugar is 70 mg/dL (milligrams per deciliter) or less. You will likely experience a set of symptoms, such as shakiness and dizziness, and feel acutely ill. Without treatment, hypoglycemia can lead to serious and even severe symptoms and complications like a coma.

a young man checking his blood sugar

BernardaSv / Getty Images

What Is Hypoglycemia?

Hypoglycemia occurs when your blood glucose levels are too low. Typically, blood sugar levels should be at or above 70 mg/dL. If blood sugar dips below 70 mg/dL, you can start experiencing symptoms. Some of these symptoms are more severe than others.

The most common cause of hypoglycemia is taking too much of the insulin medications used to treat diabetes. Since these drugs can bring high blood sugar levels down, they have the potential to bring your blood sugar levels too far down and lead to hypoglycemia.

If you don’t have diabetes, hypoglycemic episodes can happen due to excessive alcohol consumption, illnesses, insulin overproduction, or hormone deficiencies.

Symptoms of a Hypoglycemic Episode

Low blood sugar symptoms can start and progress quickly. Symptoms typically start mildly and may not be recognized right away.

Symptoms include:

  • Feeling shaky
  • Being nervous or anxious
  • Sweating or experiencing chills and clamminess
  • Feeling irritable or impatient
  • Feeling confused
  • Having a fast heartbeat (tachycardia)
  • Feeling lightheaded or dizzy
  • Feeling hungry
  • Feeling nauseous

If left untreated, symptoms can progress to dangerous, severe symptoms, including:

  • Coordination problems
  • Nightmares
  • Seizures

Hypoglycemia can go undetected. Hypoglycemic unawareness is common but can be dangerous, and people with diabetes should be aware of the symptoms to treat low blood sugar before serious complications arise.

How to Treat Hypoglycemia

Step 1: Recognize the Symptoms

Knowing the signs of a hypoglycemic episode is critical to treating it early and avoiding severe complications. If you or someone you know has symptoms of hypoglycemia, the next step is confirmation.

Step 2: Confirm Low Blood Sugar Level

Since symptoms of hypoglycemia are non-specific and can be caused by other conditions, it’s important to confirm low blood sugar levels by measuring your blood glucose with a glucometer.

Step 3: Start Treatment

A quick way to treat a hypoglycemic episode is with the 15-by-15 rule. It states that you should raise your blood sugar gradually by eating or drinking at least 15 grams of carbohydrates, waiting 15 minutes, and checking your blood sugar again. If your blood sugar is still below 70 mg/dL, repeat the steps until you feel better.

The following are examples of 15 grams of carbs:

  • Glucose tablets
  • Gel tube
  • 4 ounces of juice or regular soda
  • 1 tablespoon of sugar, honey, or corn syrup
  • Hard candies, jellybeans, or gumdrops (read the package label to determine how much to eat)

Glucagon can be used along with emergency treatment to manage low blood sugar. It comes as a liquid in a pre-filled syringe and an auto-injector device for you to inject just under the skin. Glucagon is also available as a powder, which can be mixed with a provided liquid to be injected into the skin, muscle, or vein.

After injecting glucagon, the patient should be turned onto their side to prevent choking if they vomit. Use glucagon injection exactly as directed. Do not inject it more often or inject more or less of it than prescribed by your healthcare provider.

Step 4: If Treatment Isn’t Working, Call 911

If symptoms aren’t improving after multiple tries of the 15-by-15 rule, seek emergency medical attention right away.

The Importance of Acting Fast

Correct and adequate treatment for a hypoglycemic episode is crucial. While some people may want to start drinking and eating all carbohydrates or sugar in sight, this can have too strong of an effect and spike levels over the top of normal levels. The key to treating a hypoglycemic episode is to be educated and aware of the signs and have food or snacks on hand to treat slowly.

Recovering from a Hypoglycemic Episode

In mild hypoglycemic episodes, treatment shouldn’t take longer than 15 to 20 minutes to work.

Preventing Hypoglycemic Episodes

Sometimes, an attack may be inevitable if medication isn’t balanced or there is a change in diet or lifestyle.

Plan Meals

Regular meals and mealtimes play a critical role in regulating blood sugar. When it comes to planning meals, it’s best to eat smaller meals more often, instead of heavy meals only a few times a day.

Work with your healthcare team to understand the best diet recommendations for you, including foods to avoid or eat less of. A common diet recommendation for people with diabetes is eating foods with a low glycemic index.

The glycemic index measures how much food can increase blood sugar levels. Some examples of foods with a low glycemic index include bran cereals and other grains, one to two fruits per day (including apples, strawberries, and cherries), nuts, and green vegetables.

In order to keep blood sugar level and avoid low blood sugar, meals shouldn’t be skipped or spread out by more than four to five hours throughout the day.

Stay Active at the Right Time

Exercise is great for maintaining healthy blood sugar levels, but it often lowers levels. Since people with diabetes are at risk for low blood sugar, and exercise can cause it, it’s a good idea to speak with your healthcare team to determine the best plan for you.

Your medical team may recommend exercise only if blood sugar is at a specific level, or they may recommend eating a small snack before starting your workout.

While it is important to recognize the possibility of lowering blood sugar levels, exercise is critical to health among people with diabetes.

Be Mindful of Medication

Medication is the most common cause of low blood sugar. To prevent a hypoglycemic episode, be extremely careful with your medication administration.

Be sure to only take your recommended dose, and notify your care team if there are any significant changes in your lifestyle that need to be considered for the dosage.

Work With Your Healthcare Provider

Along with discussing medications with your healthcare provider, your care team can also keep you educated and make recommendations for your unique situation. Preparation is the next best thing to prevention, and that means being aware of the signs of a hypoglycemic episode, having an emergency kit on hand, and understanding your treatment plan.


Learning to recognize the signs of a hypoglycemic episode is the best way to detect when your blood sugar level is too low. Always make sure you have food and carbs on hand, especially if you are prone to having low blood sugar.

A Word From Verywell

While hypoglycemic attacks can be frightening, it helps to know the signs of low blood sugar and treatment options to address concerns immediately when they do occur. Additional recommendations for people living with diabetes include wearing an emergency badge, keeping family in the know, and bringing emergency treatment with you when traveling.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Diabetes Association. Hypoglycemia (low blood sugar).

  2. National Institute of Diabetes and Digestive and Kidney Diseases. Low blood sugar (hypoglycemia).

  3. American Diabetes Association. Recipes and nutrition.

  4. American Diabetes Association. Blood sugar and exercise.

By Kimberly Charleson
Kimberly is a health and wellness content writer crafting well-researched content that answers your health questions.