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Boston Medical Center Health System complies with applicable Federal civil rights laws and does not discriminate on the basis of age, race, color, national origin (including limited English proficiency and primary language), religion, culture, physical or mental disabilities, socioeconomic status, sex, sexual orientation and gender identity and/or expression. BMCHS provides free aids and services to people with disabilities and free language services to people whose primary language is not English.

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Troubleshooting Low Glucose (Hypoglycemia)

617.638.7470

Low blood glucose (hypoglycemia) is when your glucose level is less than 70 mg/dl with or without symptoms. A glucose level of 54 mg/dl or less with or without symptoms can be considered a severe hypoglycemic episode.

Symptoms of hypoglycemia may include:

Sweating

Irritability

Fast Heart Beat

Low Energy

Shaking

Confusion

Hunger

Pallor (pale skin)

Treatments for hypoglycemia can vary from person to person. You and your diabetes team can discuss the best option for you. The way you react to a treatment for hypoglycemia also depends on the level of your glucose at the time of the treatment.

Severe hypoglycemia can be treated with glucagon, if unable to eat or drink. This can be injected or given as a nasal spray. It is important to have a glucagon emergency kit at home that a family member or friend know how to use and administer it to you.

If you experience frequent hypoglycemia it would be helpful for you to have a medical bracelet and a glucagon kit in your diabetes management kit.

Steps to treat hypoglycemia:

  1. If you have any symptoms of low blood sugar (BG), confirm with fingerstick.
  2. If BG <70 or <80 with symptoms 
    • Treat with 15 grams of fast-acting carbohydrate (carb) such as 4 glucose tabs or 4 ounces of fruit juice
  3. If BG <50 mg/dL
    • Treat with 30 grams of fast-acting carb
  4. If blood glucose is still less than 70 mg/dl after 15 minuts, repeat steps 2 or 3 and until blood glucose is greater than 70 mg/dl
    • If you are using a CGM – check your sugar with fingerstick
  5. If next meal is more than 1 hour away, you may need a protein + complex carb snack such as peanut butter and crackers
  6. If you are using an insulin pump you may need to have your settings adjusted if having frequent episodes of low blood sugar. If any concerns, please call your diabetes team.
  7. If you are using a hybrid closed loop system or automated insulin delivery system via an insulin pump – you may not need as much carbohydrate intake to treat a low  consider treating with ½ of the usual amount of carbs
  8. Continue to check your blood glucose frequently. If you have a continuous glucose monitor, be patient with the alarms. It can take your glucose monitor 15-30 minutes to register your treatment

Below is a list of treatment options for treating hypoglycemia

(15 grams carbohydrates)

Food

Serving Size

Food

Serving Size

Fruit Juice

½ cup (4 oz)

Glucose tabs

4 pieces

Regular soda

½ cup (4 oz)

Glucose gel

1 Packet

Life savers

5 pieces

Honey

1 tablespoon

Starbursts

4 pieces

Sugar packet

4 packets

What should you consider when trying to troubleshoot insulin pump related causes for hypoglycemia?

  • Are your basal rates set too high?
  • Are your correction factors set too low?
  • Are your insulin to carb ratios set too low?
  • Are the target levels on your pump calculator set too low?
  • Is your insulin on board (IOB) not set correctly?
  • Are you stacking insulin doses? Or eating less than expected?

If you are experiencing frequent episodes of hypoglycemia – call your diabetes team! Diabetes Clinic Phone Number: 617.638.7470

Additional Information about glucagon and managing hypoglycemia

https://www.bmc.org/diabetes/managing-hypoglycemia#glucagon