A low blood sugar is scary and it is treatable, and the steps are short enough to do while your hands are shaking. If you are reading this for yourself right now and you feel shaky, sweaty, confused, or suddenly ravenous, and your blood sugar is under 70, skip to the box and treat it first. Come back for the rest.
What counts as a low, and what does it feel like?
Blood sugar under 70 mg/dL is low (hypoglycemia). Under 55 mg/dL is severe, the range where thinking gets cloudy and you may not be able to treat yourself. The common warning signs are shakiness, sweating, a fast heartbeat, sudden hunger, irritability or anxiety, pale skin, and trouble concentrating. Lows most often come from too much insulin or diabetes medication relative to food, a skipped or delayed meal, more activity than usual, or alcohol. Some people, especially after years with diabetes, stop feeling the early warnings, which is called hypoglycemia unawareness and is a strong reason to wear a continuous glucose monitor with low alarms.
Why the 15-15 rule, and why the waiting matters
The instinct during a low is to eat everything in the kitchen, because you feel awful and your brain is demanding fuel. That is exactly how a low becomes a sky-high rebound an hour later. The 15-15 rule exists to prevent that: a measured 15 grams raises most people enough, and the 15-minute wait lets the sugar actually reach your blood before you decide whether you need more. Recheck at 15 minutes. Still under 70, repeat the 15 grams. Once you are back above 70, if your next meal is more than an hour away, have a small snack with some protein (crackers and peanut butter, half a sandwich) so it holds.
What to use, and what not to reach for
- Best: glucose tablets or gel, because the dose is exact and they are made for this.
- Good: 4 oz of juice or regular soda, a tablespoon of sugar, honey, or jam.
- Slow, avoid for treating a low: chocolate, candy bars, ice cream, cookies. The fat slows the sugar down, so they raise you too late.
- Not a treatment: diet soda and anything sugar-free. No usable sugar in it.
When a low is a 911 emergency
If a person with diabetes is unconscious, having a seizure, or too confused to swallow safely, this is severe hypoglycemia and it is an emergency. Do not try to give food or drink, which can go into the lungs. Instead: give glucagon if it is available (a nasal spray or pre-filled pen that any bystander can use), turn the person on their side, and call 911. Glucagon is the reason everyone on insulin should have a prescription for it and should have shown a family member, roommate, or coworker where it lives. After a severe low, tell your care team, because it usually means the medication plan needs adjusting.
How to stop it from happening again
One low is a moment; a pattern of lows is a signal. If lows keep coming, especially at the same time of day, at night, or after a medication change, that is your plan telling you a dose or timing is off. Keep a simple record of when lows happen and what preceded them (a missed meal, a workout, a new prescription), and bring it to a same-week call with your doctor. Sulfonylureas and insulin are the usual culprits, and the fix is often a small, deliberate adjustment. Recurrent lows are not something to just live with.
How Kite handles this
In the moment, text Kite "my blood sugar is 60 and I feel shaky" and it walks you through the 15-15 steps and tells you the line for calling 911, so you are not searching while your hands shake. Between episodes, it logs when your lows happen and helps you spot the pattern to bring to your doctor. It is not a substitute for your care team or for glucagon. Text Kite to start.