How to Treat Low Blood Sugar (without the Roller Coaster)
If you have diabetes, you understand how frustrating, annoying, and sometimes, darn-right scary, lows can be.
You also know that the 15-15 rule is kind of a joke. If you go to an Endocrinologist for your diabetes, you have most likely heard the advice, "if you are low, simply eat 15 grams of fast acting carbs, wait 15 min. Repeat as needed".
I am a T1D, a Dietitian, and a Diabetes Educator. When I am low, I do not think, "oh I am low, 15 grams is perfect and is all I need". Then patiently wait 15 min.
No. Not even a little. It's more like...
"I'm LOW! I need food NOW! And not just 15 grams, I need to eat everything in sight."
Yes 1/3 - 1/2 cup of juice = 15 grams, BUT do I EVER stop at 1/3 - 1/2 cup if I'm drinking juice when I'm low?
No. Not ever. I would drink the whole container, however large it is because my brain is saying, "YOU'RE LOW, you need more juice, keep drinking until you feel better!!"
If I'm low and there is a plate of cookies around, do I eat 1 medium sized cookie?
My son Barrett when we made Christmas cookies last week. No way was he only going to eat 1 cookie. Look at his little expression! And he's not diabetic, just me.
No. I eat 1 cookie. Attempt to wait 15 min, but it's more like 2 minutes, then I eat another cookie. REPEAT.
This process repeats until I have eaten about 5-6 cookies. Which is closer to about 75 - 90 grams. Which is much much more than the recommended 15 grams.
My point. When you are low (Type 1 and Type 2), I tell my patients, your logical self is gone, and the caveman brain version of you takes over.
The caveman brain is all about survival, not logic.
My trick for properly treating lows is to take out ALL brain work BEFORE you have your low.
Let me explain.
Below are my 7 Tips to Treat your Low Blood Sugar (without the Roller Coaster).
1. Don't Keep a Jug of Juice in the Fridge
This may come as a shocker to you, but in my personal experience and with patients, when you are low, you will drink much, MUCH more than 15 grams needed when drinking from a large container of juice. Having a jug of juice in the fridge is too easily accessible.
If you are parent with a child with diabetes, your child is going to be low and if you give juice, you will want your child to snap out of the low FAST, if your child doesn't, you will get panicky, and therefore give more, and more, and more juice. 1 hour later, your child is at 300+ mg/dL.
The first 1/2 cup of juice was enough, but out of hysteria, you juiced WAY too much.
Even if you are the with diabetes (the adult), drinking from a container of juice in the fridge is going to make it too easy for the caveman brain to take over and demand you to double, triple, maybe quadruple the amount you actually need.
HOWEVER, juice may work for you if you those little, tiny prepackaged juice boxes. But even still, 15 grams may be too much to bring up a modest low, especially if you use Basal-IQ or a 670G system because the basal insulin has been cut out for a bit before you were able to treat (most likely), therefore you don't need as much glucose to bring up that low.
I'll say it again. A jug of juice waiting in the fridge is TOO easily accessible which can make it too easy to drink way too much and thus cause the Roller Coaster ride with your blood sugar.
2. Don't Treat with Goodies
Goodies. AKA high fat, high sugar treats such as donuts, cookies, cake, brownies, candy bars (i.e. snickers, 3 musketeers, kit kats, etc). You know, "the good stuff".
I have had many patients say, "If I'm low, I'm going to enjoy and eat something I like!"
Eating goodies when you are low makes it too easy to overeat, especially when the caveman brain is in charge. Not only do you eat way too much, goodies also contain fat and protein, which is higher in calories, and will slow the glycemic load which will make it take longer for your blood sugar raise to normal levels.
The longer you feel low, the longer you are will feel pressure to keep eating.
Goodies = high calorie.
Carbs = 4 calories per gram
Fat = 9 calories per gram,
Protein = 4 calories per gram
NOTE: Protein may be necessary after eating a fast-acting carb if you have a stubborn low that keeps falling back down. Eat the fast-acting carb FIRST, then if the low is persistent, THEN add a protein, maybe a fast-acting carb and protein if needed.
When you eat a food that is combination of fat, protein, and carbs, the fat and protein are just extra sources of calories because they are not bringing up your blood sugar like the carbs.
PATIENT STORY: No Weight Loss?
I have a patient who ate trail mix to bring up her lows, she thought she was being super healthy, but couldn't understand why (despite all her efforts), she couldn't lose weight.
1/4 cup of trail mix = 15 grams of carbs
Awesome, that is supposedly the magic number to bring up a low, BUT 1/4 cup trail mix also contains 200 calories, AND because of the high level of fat and moderate protein, it is going to take longer to raise a low blood sugar, therefore you are much, MUCH more likely to eat much more than just 1/4 cup.
The longer you are low, the longer the caveman brain will be in charge. The caveman brain will tell you to eat and eat for survival.
All of the sudden...
1/4 cup turns into 1/2 cup, then into 3/4 cup, then somehow into 1 full cup.
1 cup trail mix = 800 calories & 60 grams of carbs. That's a lot of calories to bring up a low...
A rise in blood sugar from trail mix will be a slower rise, and also a much more stubborn consequential high compared to a high brought on by juice. I am a big fan of fat, but I think of fat as the stubborn macro when it comes to diabetes. It can help or hurt your diabetes depending on how much and how often you eat it.
3. Eat Simple, PORTIONED carbs
Simple carbs are food sources made of straight sugar/glucose. A great source that all diabetics know of are glucose tabs.
Glucose tabs to me are expensive chunks of chalk that bring my blood sugar up. They are not tasty, they are expensive, but they get the job done.
Simple carbs are fast-acting because they have a high glycemic index, they are going to keep you from over eating as much because they bring you up more quickly (so you are sitting around with the caveman brain in charge telling you need to eat more to survive), and they are simply lower in calories.
As I mentioned earlier, I do not recommend juice, but juice is a simple carb, right?
Yes, juice is a simple carb, but this brings me to my next tip.
4. Eat PORTIONED Simple Carbs
This is important because having your fast-acting carb PORTIONED before you have the low will take the brain work out of it.
For example, one of my favorite fast-acting food sources are smarties candies. I know that 1 roll = 6 grams of fast-acting carbs. I also know it's about 25 calories.
I have a low, my caveman brain takes over, I reach for my fast-acting sugar of 1 roll of smarties, and after I eat 1 roll, I have to think, "was that enough, or do I need another one?"
After 1 portioned roll, there is a hard stop which allows me to gather my thoughts and figure out how much I really need.
Good Portioned Candy Choices...
1 Smarties Candy roll = 6 grams
1 Large Lemon Head = 7 grams
1 Airhead, snack size = 10 grams
1 Box of Nerds, fun size = 12 grams
1 pack Skittles, fun size = 14 grams
1 pack Sour Patch Kids, fun size = 14 grams
1 pack Fruit Snacks, small = 18 grams
Rather healthier options?
Good Portioned Fruit Choices...
1 tbsp dried fruit (cranberries or raises) = 8 grams
1 clementine = 8 grams
1 extra small apple (2 1/2" diameter) = 15 grams
NOTE: Fruit does contain fiber (more or less, depending on the fruit) which may cause your blood sugar take a little longer than if you just ate straight sugar as with the options above.
5. Use Simple Carbs you don't LOVE
The reason for this tip is that if you LOVE lemon heads, guess what, you are going to eat lemon heads when you are and are NOT low. That's why I suggest to purchase a simiple carb food that you are not totally crazy about. This way it helps you not overeat when you are low, and not eat it when you simply aren't lot at all.
For instance, call me crazy, I am not a huge fan of sour patch kids. When I was pregnant with my Barrett (my son in the pictures above), I ate way too many sour patch kids and now, they are never my candy of choice.
I don't find them crazy gross, but not finding them super delicious is going to help me stay in control when I hit that cavemen state from low blood sugar.
I want to add, if glucose tabs work really well for you, go for them. They are a GREAT simple carb to bring you up fast, maybe the best, I just don't like how expensive they are when smarties do they same trick.
6. Use the Reverse Method
Reverse Bolus is a pump term, but the idea still applies to all diabetics (either type and whatever way you administer short-acting insulin/medication when you eat carbs).
With a Reverse Bolus on your pump, you have the ability to set a target blood sugar and a low glucose minimum.
Low Glucose Minimum - Below this number, your pump will not give you insulin, no matter how many carbs you tell your pump you are eating to treat that low (which is why I set this limit to around 55 - 65 mg/dL, depending on the pt).
Target Blood Sugar - This is the goal blood sugar you set in your pump (unless you are using a 670G Medtronic pump). Therefore if you put in a number between your lower target blood sugar range number and your low glucose minimum, then put in your carbs, your pump is going to automatically adjust so you receive a lower amount of insulin in order to get back up to your target range.
Let me just say, I think a diabetic made this feature because how often do you eat much more than what you intended to bring up a low, or you were just hungry, and you happen to be low? This feature takes the low into account, but still allows you to give the right amount of insulin so that you don't have a monster high once all of those carbs take into effect.
My last tip, but definitely not least...
7. Treat for the Severity
Meaning that having a low number is not super straight forward. There are different levels of severity for a low and they usually need to be treated with different amounts of sugar.
The graph below is part of a handout I use with my patients, its a good source to go by as you are figuring out exactly what your body needs to bring up a mild, moderate, or severe low blood sugar.
Note #1: These amounts are dependent on you, where your blood sugar is trending (by watching a Continuous Glucose Monitor), how much you exercised, if you are about to exercise, etc. But this chart should help you get started.
Note #2: The lower your insulin : carb ratio, the less sugar you will need to bring up your blood sugar.
For example, a person with diabetes who has a 1:20 insuliln to carb ratio is going to need more carbs to bring up a low than a person with a 1:5 insulin to carb ratio.
In another post, we will talk about how nutrition greatly impacts your insulin to carb ratio and insulin sensitivity.
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The purpose of all my posts is to give you direction from a Diabetes Educator who understands your struggles as a I diabetic. These posts are not individualized to your specific needs and situation, but it is a start.
I was diagnosed with diabetes at the age of 4, so I know how it feels to grow up with it. I have been there through the annoying highs, the scary lows, the frustrating times when you either feel broken or insulin just doesn't work on you anymore. A thousand times, I get it.
Me when I was diagnosed at age 4.
I work as a Diabetes Educator 2 days a week at a Diabetes clinic, but on my days off, I work through my Online Private Practice with people with type 1 and type 2 diabetes across the U.S.
If you are in need of someone to help you make adjustments with your insulin/diabetes medication, you feel all over the place and need help making sense of your diabetes, you need help with your nutrition and/or fitness, send me an email so we can schedule a face-to-face video chat.
I truly care about my patients, and I want to help you learn how you can manage your diabetes and be in better control. Together, we will comb through your blood sugars, your nutrition and exercise routine, and help you achieve a much improved HbA1c.
Email is the best way to reach me: firstname.lastname@example.org
Your friend, dietitian, T1D, and Diabetes Educator
Ariel Warren, RD, CD