The best treatment for hypoglycemia depends on how severe it is. For mild to moderate low blood sugar (below 70 mg/dL), the standard approach is the 15-15 rule: eat 15 grams of fast-acting carbohydrates, wait 15 minutes, then recheck your blood sugar. For severe episodes where someone is unconscious or unable to eat, emergency glucagon is the primary treatment. Beyond these immediate fixes, long-term management focuses on preventing episodes from happening in the first place.
The 15-15 Rule for Mild Low Blood Sugar
If your blood sugar drops below 70 mg/dL but you’re still alert and able to eat, the CDC recommends following the 15-15 rule. Eat or drink 15 grams of fast-acting carbohydrates, wait 15 minutes, then test again. If your blood sugar is still below 70, repeat the process until it returns to your target range.
Fifteen grams of fast-acting carbohydrates looks like any one of these:
- 3 glucose tablets
- Half a cup (4 ounces) of fruit juice or regular soda
- 6 or 7 hard candies
- 1 tablespoon of sugar
Glucose tablets are often the most reliable option because they deliver a precise amount of sugar without the guesswork. Juice and soda work well too, but avoid diet versions since they contain no sugar. Once your blood sugar stabilizes, follow up with a balanced snack or small meal that includes both protein and carbohydrates. This prevents your blood sugar from dropping again after the fast-acting sugar wears off. For young children, especially infants and toddlers, less than 15 grams may be appropriate.
Emergency Treatment for Severe Episodes
Severe hypoglycemia means your blood sugar has dropped below 55 mg/dL, or you’re too disoriented or unconscious to safely eat or drink. This is a medical emergency. Never try to put food or liquid into the mouth of someone who is unconscious or seizing, as they could choke.
Glucagon is the emergency treatment. It’s a hormone that signals your liver to release stored sugar into the bloodstream, and it’s available in two forms: injectable and nasal spray. The nasal version, approved in 2019 for anyone age 4 and older, is significantly easier for bystanders to use. In simulation studies, caregivers administered the nasal spray in under a minute, compared to 1.3 to 5 minutes for the injectable form. Both versions raise blood sugar within 15 to 30 minutes, with no meaningful difference in effectiveness.
If someone is experiencing severe symptoms that don’t improve after glucagon, including extreme weakness, loss of consciousness, seizures, severe confusion, or slurred speech, call 911 immediately.
Preventing Lows With Technology
For people with type 1 diabetes or those on insulin, continuous glucose monitors (CGMs) have changed how hypoglycemia is managed. These devices track blood sugar in real time and can send predictive alerts before a low actually happens, giving you time to eat something and avoid an episode entirely.
Some insulin pumps take this a step further with a feature called predictive low-glucose suspend. The pump uses an algorithm to predict your glucose level 30 minutes ahead. If it detects that you’re heading below 80 mg/dL, it automatically pauses insulin delivery. The suspension can last anywhere from 5 minutes to 2 hours and resumes once glucose starts rising again. Clinical trials have shown this technology reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes.
Restoring Awareness When You Stop Feeling Lows
Some people with diabetes experience repeated low blood sugar episodes to the point where their body stops producing the usual warning signs, like shakiness, sweating, or a racing heart. This condition, called hypoglycemia unawareness, is dangerous because you can become severely low without realizing it.
There’s no direct medication for this, but research dating back to the 1990s has consistently shown that strictly avoiding low blood sugar for a period of weeks can partially or fully restore your body’s ability to recognize and respond to drops. The key is breaking the cycle: the more lows you have, the less you feel them, and the less you feel them, the more lows you have. CGMs are particularly valuable here because they catch lows you might otherwise miss, making strict avoidance realistic in a way it wasn’t before these devices existed.
Managing Reactive Hypoglycemia Without Diabetes
Not all hypoglycemia is related to diabetes. Reactive hypoglycemia happens when blood sugar drops too low a few hours after eating, typically triggered by simple carbohydrates and sugary foods that cause a rapid spike followed by an overcorrection. If this is your pattern, the treatment is mostly dietary.
The core strategy is replacing simple carbohydrates with complex ones. Foods like white bread, white rice, pasta, pancakes, candy, and sweetened drinks break down into sugar almost immediately, creating the spike-and-crash cycle. Swapping these for complex carbohydrates creates a more gradual rise and fall in blood sugar. Good options include brown or wild rice, quinoa, oatmeal, sweet potatoes with the skin, winter squash, sprouted grain breads, and legumes like beans, lentils, and split peas.
Pairing carbohydrates with protein and healthy fat slows digestion even further. Lean meat, fish, eggs, nuts, tofu, cottage cheese, and Greek yogurt all work. Nuts are particularly efficient because many varieties deliver carbohydrates, protein, and healthy fat in a single snack. Eating smaller meals or snacks every two to four hours, rather than going long stretches without food, also helps keep blood sugar stable throughout the day.
Medications That Can Cause Low Blood Sugar
If you’re experiencing hypoglycemia and aren’t sure why, your medications may be a factor. Several drug classes are known to lower blood sugar, sometimes unexpectedly. Insulin is the most obvious, but sulfonylureas and glinides (both diabetes medications) are common culprits. Metformin can contribute when combined with sulfonylureas, and certain newer diabetes drugs called SGLT2 inhibitors carry risk as well.
Beyond diabetes medications, some drugs prescribed for completely unrelated conditions can also trigger lows. Certain antibiotics, beta-blockers used for blood pressure and heart conditions, heart rhythm medications, and even some pain relievers have been linked to drug-induced hypoglycemia. If you’re having unexplained episodes of low blood sugar, reviewing your medication list with your prescriber is a practical first step, since adjusting the dose or timing of a single medication can sometimes resolve the problem entirely.