What should I eat to treat acute hypoglycemia and prevent future episodes?

What to Eat for Hypoglycemia

For acute hypoglycemia (blood glucose ≤70 mg/dL), immediately consume 15-20 grams of pure glucose in the form of glucose tablets or glucose solution, as this is the most effective treatment to rapidly raise blood glucose levels. 1, 2

Immediate Treatment Protocol

First-Line Treatment

• Consume 15-20 grams of pure glucose (glucose tablets or glucose solution) as soon as blood glucose drops to 70 mg/dL or below 1, 2
• Pure glucose is superior because the glycemic response correlates better with actual glucose content than with total carbohydrate content 1, 2
• Glucose tablets raise blood glucose by approximately 40 mg/dL within 30 minutes with 10 grams, and 60 mg/dL within 45 minutes with 20 grams 1

Alternative Carbohydrate Sources (If Glucose Unavailable)

• Any carbohydrate-containing food that includes glucose can be used, though less effective than pure glucose 1, 2
• Sucrose (table sugar) in tablet or solution form is nearly as effective as glucose 1, 3
• Avoid orange juice and glucose gel as they are significantly less effective at quickly raising blood glucose and alleviating symptoms 1, 3

Critical Timing and Monitoring

• Expect symptom improvement within 10-20 minutes after consuming glucose 1, 2
• Recheck blood glucose at 15 minutes; if still low, immediately repeat another 15-20 grams of glucose 1, 2
• Recheck again at 60 minutes as additional treatment may be necessary, since glucose levels begin falling again after initial correction 1, 2

Post-Recovery Nutrition

Preventing Recurrence

• Once blood glucose normalizes, immediately eat a meal or snack containing complex carbohydrates and protein to prevent recurrent hypoglycemia 1, 2
• Examples include crackers with cheese, a meat sandwich, or a combination of long-acting carbohydrates with protein 4
• This step is critical because ongoing insulin activity or insulin secretagogues can cause hypoglycemia to return 1

What NOT to Eat During Acute Hypoglycemia

Foods to Avoid

• Do not add fat to your carbohydrate treatment (avoid chocolate, cookies, ice cream initially) as fat slows and prolongs the glycemic response, delaying recovery 1, 2
• Do not use protein-rich foods alone (cheese, nuts, meat) to treat acute hypoglycemia, as protein may stimulate insulin release without raising blood glucose, particularly in type 2 diabetes 1, 2
• Avoid orange juice as initial treatment—it contains fructose which is less effective than glucose at raising blood glucose 1, 3

Special Situations

Severe Hypoglycemia (Unconscious or Unable to Swallow)

• If you cannot safely swallow or are unconscious, glucagon injection or intranasal glucagon must be administered by a caregiver 1, 2, 4
• Adult dose: 1 mg; children <44 lbs (20 kg): 0.5 mg 4
• After glucagon administration and awakening, consume fast-acting sugar (regular soft drink or fruit juice) followed by long-acting carbohydrates 4

Resistant or Recurrent Hypoglycemia

• If hypoglycemia persists despite two treatments of 15-20 grams glucose, this constitutes resistant hypoglycemia requiring emergency medical attention 5
• Sulfonylurea-induced hypoglycemia requires 24-48 hours of observation and may need continuous dextrose infusion due to prolonged drug action 5
• Alcohol-related hypoglycemia requires intravenous dextrose as primary treatment, not oral carbohydrates 5

Common Pitfalls to Avoid

• Never delay treatment while waiting for blood glucose confirmation—treat symptoms immediately 2
• Do not assume one treatment is sufficient—always recheck at 15 and 60 minutes 1, 2
• Do not overtreated—stick to 15-20 grams initially to avoid rebound hyperglycemia 1, 2
• Do not use diet beverages or sugar-free products—they contain no glucose and will not raise blood glucose 4

Prevention Strategy

Daily Preparedness

• Always carry glucose tablets or candy with you at all times 2, 4
• Recognize high-risk situations: fasting for tests, delayed meals, intense exercise, alcohol consumption, and sleep 1, 2
• Educate family members and close contacts on recognizing hypoglycemia symptoms and administering glucagon 1, 2

When to Seek Medical Attention

• Any episode of severe hypoglycemia requiring assistance mandates immediate reevaluation of your diabetes management plan 1, 2
• If you do not awaken within 15 minutes after glucagon administration, give another dose and call emergency services immediately 4
• Recurrent hypoglycemia despite appropriate treatment requires hospital admission 5