Does protein help with hypoglycemia?

Protein Does Not Help with Hypoglycemia Treatment

Pure glucose or carbohydrates containing glucose are the preferred treatment for hypoglycemia, while protein has no benefit in treating or preventing hypoglycemia. 1

Evidence on Protein and Hypoglycemia

The American Diabetes Association's position is clear on this matter:

• Adding protein to carbohydrate does not affect the glycemic response during hypoglycemia 1
• Protein does not prevent subsequent hypoglycemia when added to carbohydrate 1
• In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations 1
• Therefore, protein should not be used to treat acute hypoglycemia or prevent nighttime hypoglycemia 1

Proper Hypoglycemia Management

Immediate Treatment

For conscious individuals with hypoglycemia (blood glucose <70 mg/dL):

1. Administer 15-20g of fast-acting carbohydrates 1, 2

   • Pure glucose is preferred
   • Any form of carbohydrate containing glucose can be used
   • Examples: glucose tablets, sugar cubes, Skittles, Mentos, jelly beans, or orange juice 1

2. Recheck blood glucose after 15 minutes 2

   • If hypoglycemia persists, repeat treatment
   • Once blood glucose returns to normal, consume a meal or snack to prevent recurrence 1

3. For severe hypoglycemia (requiring assistance):

   • Administer glucagon 1, 2
   • Glucagon administration is not limited to healthcare professionals 1

Why Protein Is Not Effective

The reason protein doesn't help with hypoglycemia includes:

• Slow conversion of protein to glucose 3
• Less protein being converted to glucose than previously thought 3
• Glucose from protein being incorporated into hepatic glycogen stores without increasing hepatic glucose release 3
• The process of gluconeogenesis from protein occurs over hours, not minutes 3

Special Considerations

Bedtime Snacks and Nocturnal Hypoglycemia

While protein alone doesn't prevent hypoglycemia, research suggests:

• A standard snack containing both carbohydrate and protein may help prevent nocturnal hypoglycemia in patients with type 1 diabetes 4
• The need for a bedtime snack depends on bedtime glucose levels:
  • At levels >10 mmol/L (180 mg/dL): no snack necessary
  • At levels 7-10 mmol/L (126-180 mg/dL): any snack is advised
  • At levels <7 mmol/L (126 mg/dL): a standard or protein-containing snack is recommended 4

Exercise-Related Hypoglycemia

For post-exercise hypoglycemia prevention:

• Carry fast-acting carbohydrates during physical activity 2
• Monitor glucose before, during, and after exercise 2

Common Pitfalls to Avoid

1. Don't delay treatment with inappropriate foods: Using protein-only foods to treat acute hypoglycemia will delay recovery and may worsen symptoms.

2. Don't confuse prevention with treatment: While mixed meals containing protein may have a role in preventing future hypoglycemia in certain contexts, protein alone is ineffective for treating active hypoglycemia.

3. Avoid fructose-containing treatments: Fructose is less effective than glucose or sucrose in raising blood glucose levels during hypoglycemia 1.

4. Don't over-treat: Providing excessive sugar can lead to "over-shooting" blood glucose goals, which may be harmful if repeated over time 1.

In conclusion, for treating hypoglycemia, rely on fast-acting carbohydrates containing glucose, not protein. The evidence clearly shows that protein does not improve the glycemic response during hypoglycemic episodes.