What are the best foods to consume during a hypoglycemic episode?

Best Foods for Hypoglycemic Episodes

Pure glucose tablets (15-20 grams) are the single best treatment for hypoglycemia, as they raise blood glucose more rapidly and effectively than any other carbohydrate source. 1

Preferred Treatment Options

Glucose tablets or pure glucose should always be your first choice because the glycemic response correlates better with glucose content than with total carbohydrate content of food. 2

First-Line Treatment (in order of preference):

• 15-20 grams of pure glucose tablets - This is the gold standard recommended by the American Diabetes Association and American Heart Association 1
• Glucose gel - Though less effective than tablets in some studies, still contains pure glucose 2
• 4-8 ounces of regular (non-diet) soda or fruit juice - Acceptable alternatives when glucose tablets unavailable 1
• 1 tablespoon of table sugar, honey, or corn syrup - Simple alternatives that work 1

Foods to AVOID During Hypoglycemia:

• Orange juice - Significantly less effective than glucose tablets, with minimal blood glucose increment at 10 minutes 2, 3
• Milk - Contains lactose which raises glucose more slowly than pure glucose 4
• Foods with fat - Fat retards the acute glycemic response and delays recovery 2
• Foods with protein alone - Adding protein does not improve the glycemic response or prevent subsequent hypoglycemia 2

Treatment Protocol

Check blood glucose immediately when hypoglycemia is suspected - If testing unavailable, treat anyway. 2

Step-by-Step Algorithm:

1. Consume 15-20 grams of glucose as soon as blood sugar drops to 70 mg/dL or below 1
2. Wait 15 minutes and recheck blood glucose 2, 1
3. If still below 70 mg/dL, repeat the 15-20 gram dose 1
4. Evaluate again at 60 minutes - Additional treatment may be necessary as blood glucose can begin falling again after initial correction 2
5. Once blood glucose >70 mg/dL and more than 1 hour until next meal, consume starchy or protein-rich foods to prevent recurrence 2

Special Populations & Situations

Insulin Pump Users with Automated Delivery:

• Use only 5-10 grams of carbohydrates for most hypoglycemic episodes 1
• Use full 15-20 gram dose only if hypoglycemia occurs with exercise or significant meal bolus overestimation 1

Patients Taking Alpha-Glucosidase Inhibitors:

• Must use monosaccharides like glucose tablets - These medications prevent digestion of complex carbohydrates, making juice and other polysaccharides ineffective 2

Unconscious or Severely Impaired Patients:

• Never attempt oral administration 2
• Administer glucagon 0.5-1.0 mg intramuscularly 2
• Or 20-40 mL of 50% glucose solution intravenously 2
• Call emergency services immediately 5

Critical Pitfalls to Avoid

Overtreatment is extremely common - Real-world data shows 50% of patients consume more than 20 grams, with 22% consuming over 30 grams, leading to rebound hyperglycemia. 6

Low glycemic index foods are frequently misused - Many patients choose fruit juice, milk, bread, or cookies, which have significantly slower glycemic responses than pure glucose. 6

Early warning symptoms may be absent in patients with long-standing diabetes, autonomic neuropathy, or those on beta-blockers - These patients must monitor blood glucose more frequently, especially before driving. 5

Prevention Strategies

Always carry glucose tablets - Keep them at bedside, in car, at work, and in all bags. 1

Wear medical alert identification stating diabetes diagnosis. 1

Educate family, roommates, and coworkers on recognizing and treating hypoglycemia, including how to administer glucagon. 1

During Illness

Continue insulin even when sick - Never omit insulin during acute illness. 2

Consume 150-200 grams of carbohydrate daily (45-50 grams every 3-4 hours) to prevent starvation ketosis. 2, 1

Use liquid carbohydrates if unable to eat solid food - Regular soda, juice, or sports drinks are appropriate during illness. 2

Monitor blood glucose and ketones more frequently during any acute illness. 2, 1