If you are taking any diabetes meds or insulin, there is always the possibility that your blood glucose could go too low. You should always carry with you a small supply of glucose tablets, along with your travel meter and test strips.
If you have physical symptoms (shakiness, nervousness, dizziness, trembling, sweating, weakness, etc.), that might indicate low blood sugar. But those same symptoms could also indicate high blood sugar. The only way to know for sure is to check your blood glucose with your meter.*
A blood glucose number over 70 mg/dL (3.9 mmol/l) is considered a “false low,” which feels low because you are used to having much higher blood glucose numbers! As you bring your numbers down, eventually numbers in the normal range of 70-99 mg/dL (3.8-5.6 mmol/l) will feel quite normal.
Anything under 67 mg/dL (3.8 mmol/l) is considered a true low blood sugar and you should treat it if you want to stay conscious. The best treatment for low blood sugar is pure glucose.
You may have heard people say to drink a glass of orange juice or eat a peanut butter sandwich or hard candies. These might “work” in an emergency, but none of these is ideal! Why? Dr. Richard K. Bernstein, author of Diabetes Solution, says, “Glucose, the sugar of blood sugar, does not have to be digested or converted by the liver into anything else. Unlike other sweets, it’s absorbed into the blood directly through the mucous membranes of the mouth, stomach, and gut.”1 Table sugar is sucrose, a combination of glucose and fructose. Fruit is also a mixture of the sugars. Only glucose is, well, glucose!
Typically, one glucose tablet has 4 grams of sugar. Dr. Bernstein says that 1 gram of pure glucose will raise your blood glucose about 5 mg/dL (0.2 mmol/l), so one tablet would raise your blood glucose by 20 mg/dL (1.1 mmol/l).1
If your meter shows you to have true low blood glucose:
- Take one glucose tablet (or one-half a tablet).
- Wait 20 minutes. Wash your hands and test your blood glucose again.
- Repeat until your blood glucose has returned to a normal range (70-99 mg/dL or 3.8-5.6 mmol/l).
- Note: “If your low blood sugar resulted from taking too much insulin or OHA (oral hypoglycemic agents), it may continue to drop after taking glucose if the insulin or OHA hasn’t finished working. You should therefore recheck your blood sugar about 45 minutes after taking the tablets to rule out this possibility and to see if you’re back where you belong.”2
That’s it! Correcting low blood sugar with glucose tablets is measurable and predictable. “Our health-care providers, educators, and all the literature in the world tells us we should treat a low [blood sugar] with glucose tablets… or another source of straight, fast-acting glucose rather than these other indulgent treats.”3
If you still feel hungry after your meter shows that your blood glucose is normal, eat a protein/fat snack, such as 1 ounce cheese, ½ ounce raw almonds, or a hard-cooked egg. Do not eat anything with primarily carbohydrates (sugars and starches).
Some people feel you should always correct your blood glucose to the “perfect” 83 mg/dL (4.6 mmol/l). One writer says, “Always correct your blood glucose level to 83 mg/dL. That is your benchmark. You don’t want to over-correct and spend hours yo-yoing through hypo and hyperglycemia.”4
However, it’s probably better to “work out exactly how much a single glucose tablet will raise your blood sugar and take that exact amount without having to worry if you’ve eaten enough—or too much.”5
*Note that your meter can be wrong. Legally, a blood glucose meter can be up to 20% higher—or lower—than your blood sugar level. So, a 70 mg/dL (3.9 mmol/l) could be 70 mg/dL (3.9 mmol/l). Or it could be between 56 mg/dL (3.1 mmol/l) and 84 mg/dL (4.7 mmol/l). How can you tell? If you really want to go to the trouble of checking, ask your doctor to order a fasting blood test (which he/she may or may not do). Bring your meter with you to the lab and test as close as you can to the time when your blood is drawn. Write down the result. When your blood test comes back, see how close it is to what the lab found. Then you will know if your meter is too high or too low.
1Bernstein, Dr. Richard K. “Raising Blood Sugars Predictably,” abstracted from Dr. Bernstein’s book Diabetes Solution © 2007 by Richard K. Bernstein, MD. http://www.diabetes-book.com/raising-blood-sugar/ (accessed on 7/30/2020).
2Bernstein, Dr. Richard K. “Using Glucose Tablets,” abstracted from Dr. Bernstein’s book Diabetes Solution © 2007 by Richard K. Bernstein, MD. http://www.diabetes-book.com/using-glucose-tablets/ (accessed on 7/30/2020).
3Coulter, Scott, LSW. “Why Glucose Tablets Really Are Best for Hypoglycemia.” Diabetes Self-management (January 12, 2017). https://www.diabetesselfmanagement.com/blog/glucose-tablets-really-best-hypoglycemia/ (accessed on 7/30/2020).
4Lisa. “Treatment of Lows (Hypoglycemia),” DiaVerge (September 22, 2015). https://www.diaverge.com/blog/2015/9/22/treatment-of-lows-hypoglycemia (accessed on 7/30/2020).
5Thompson, Tamsin. “5 Reasons You Should Treat a Hypo with Glucose Tabs (and Nothing Else),” Type 1 Diabeater (December 10, 2015). https://type1diabeater.com/2015/12/10/5-reasons-you-should-treat-a-hypo-with-glucose-tabs-and-nothing-else/ (accessed on 7/30/2020).
Additional Supporting Articles
Raising Blood Sugars Predictably
by Dr. Richard K. Bernstein
Using Glucose Tablets
by Dr. Richard K. Bernstein
5 REASONS YOU SHOULD TREAT A HYPO WITH GLUCOSE TABS (AND NOTHING ELSE)
Treatment of Lows (Hypoglycemia)
Why Glucose Tablets Really Are Best for Hypoglycemia
Conversion Chart from mg/dL to mmol/l