Diabetes Mellitus is a disorder that disrupts the way your body uses sugar. Sugar is used by your body to create and utilize energy in order for your cells to perform. Your body requires the perfect level of blood sugar in order to run smoothly. Otherwise, too high or too low blood sugar levels cause problems.
How Insulin affects blood sugar levels
Sugar gets into each cell with the help of a hormone called, insulin. Insulin is the key that opens the door to cells that allow sugar to enter. If there is not enough insulin, or your body stops responding to insulin, then you are left with a buildup of sugar in the blood. This buildup of sugar in the blood is called “hyperglycemia”. This is what happens when you have diabetes; your blood sugar levels rise due to the fact that insulin is not helping the sugar molecules enter your cells. Your blood sugar levels may also fall to dangerous levels due to many factors. Too low of blood sugar is called “hypoglycemia”. If diabetics have to monitor blood sugar levels, one might ask how much sugar is allowed or even recommended?
Can a diabetic have sugar?
Yes, people with diabetes can have sugar, but you must record and pay attention to the amount of sugar you consume on a daily basis. Every meal needs to be examined with a watchful eye to make sure you are not eating too much sugar or carbohydrates. The food your body consumes is broken down into three basic structures. These structures are called, carbohydrates, proteins and fats. Carbohydrates or “carbs” are sugars that our bodies use for energy. Some examples of carbohydrates include:
- Bread, pasta, rice
- Foods with added sugar or processed sugar (cakes, candy, soda, think “junk” food)
It is best to get sugar that is naturally occurring in whole foods such as carbohydrates from fruits, vegetables, whole grains, and low-fat milk. Diabetics should stick to whole foods that have not been processed such as vegetables and fruits. Try to limit bread, pasta, rice, foods with added sugar, alcohol, and especially desserts or “sweats”. If you have a sweet-tooth, try sugar-free candy or dessert.
Treating Low Blood Sugars
Most diabetics that are diagnosed with the disorder are placed on medications to help lower blood sugar levels. Medications along with a low carbohydrate diet and exercise can manage, treat, and in some cases cure diabetes. The risk of taking medications that lower a person’s blood sugar is that a person can pass out or worse. Hypoglycemia (low blood sugar) can be caused by taking too much diabetes medication, not eating enough food, exercising too much without eating a snack, exercising and not reducing your insulin dose, waiting too long to eat between meals, or drinking too much alcohol.
Signs and symptoms of low blood sugar:
- Feeling hungry
- Feeling worried
- Trouble walking or talking
- Feeling weak or tired
- Trouble seeing clearly, blurry vision
- Confusion or acting in a strange way
- Dizziness or passing out
- Seizure or coma (most serious)
Like the old saying in the medical field goes, “If he is cold and clammy, give him a piece of candy”. Meaning if you are sweating and trembling, most likely you need some sugar, because you’re hypoglycemic.
Understanding low blood sugar
Hypoglycemia is defined as any blood sugar level <70 mg/dL or any blood sugar level that causes the above symptoms. Some people become accustomed to lower-end blood sugar levels. Doctors call this unawareness of symptoms, “hypoglycemia unawareness”. People with this often have more severe symptoms, because they might not know that they have low blood sugar until symptoms become severe.
Reversely, some people become accustomed to very high blood sugar levels. This is why when people start treatment and blood sugar levels begin to trend down to “normal” ranges, patients sometimes complain of feeling tired or weak. This is simply the body adjusting to appropriate blood sugar levels. You recognize different symptoms within your body, and will begin to develop a keen sense for danger, particularly when blood sugar levels drop.
Treatment plan for hypoglycemia
What are the steps to treat hypoglycemia? The first thing to do if you have low blood sugar is to eat something, preferable something with sugar. Quick sources of sugar are good to have stashed around the house, in your purse, car, work desk, or bedside tables. In case of emergencies, you should always carry quick sources of sugar, if you are a diabetic. You can treat low blood sugar by eating or drinking quick sources of sugar. Examples of quick-sugar sources include:
- 3-4 glucose tablets
- ½ cup of juice or regular soda (not diet soda- diet soda does not have sugar in it)
- 2 tablespoons of raisins
- 4-5 saltine crackers
- 1 tablespoon of sugar
- 1 tablespoon of honey or corn syrup
- 6-8 hard candies
These sources of sugar act quickly to treat low blood sugar levels. People with diabetes who use insulin or other diabetes medicines should carry at least one of these items at all times. We recommend glucose tablets.
How to treat low blood sugars step by step:
Step 1: Once low blood sugar levels are detected and verified, eat 15 to 20 grams of fast-acting carbohydrates (listed above).
Step 2: Wait 15 minutes, then recheck blood sugar level
Step 3: If blood sugar levels are still <70, eat another 15 to 20 grams of fast-acting carbohydrates (listed above).
Step 4: Repeat steps 2 and 3 until blood sugar is above 70 mg/dL
Step 5: Once blood sugar is back to normal range, it is important to have a snack or meal to help stabilize your blood sugar. Example of snacks include: apple and peanut butter, crackers and cheese, or cottage cheese and peaches.
Why glucose tablets are better than a candy bar (pizza effect):
Glucose tablets are easy to use, cheap, consistent, fast acting and create sharp rises in glucose levels. Glucose tablets are better than candy bars because they provide the same “dose” of sugar each time. This allows for straight, fast acting sugar to increase low blood sugar levels and peak after about 10 minutes.
The pizza effect is when blood sugar increases initially, but because of added fat in pizza, it results in unexpected blood sugar increases, hours later. Candy bars also have fat in them which slows down absorption of carbohydrates. When you eat a combination of fat and carbs, it results in inconsistent increases in blood sugar levels, often leading to good-intended overcorrections. You were too low, but now you are too high. Glucose tablets will increase blood sugar every time, quickly and safely; without the surprise spikes in blood sugar later on.
Research and glucose tablets
Research studies often describe how glucose tablets work best for correcting low blood sugar levels. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states that taking 4 glucose tablets is appropriate when your blood sugar level is below 70 mg/dL. The Center for Disease Control and Prevention (CDC) also mentions glucose tablets as a first line of defense against low blood sugar. Taking glucose tablets for low blood sugar is one of the standard protocols in the medical community. Again, glucose tablets work better because they are reliable, effective, and easy to monitor.
Don’t overtreat a low blood sugar:
Being hypoglycemic can be scary and uncomfortable. Nothing feels worse than being disoriented and knowing that your blood sugar is crashing. In the heat of the moment, you may overeat fast acting sugar or even eat all the food you can get your hands on. Be careful that you do not overtreat low blood sugars due to fear and not knowing exactly what to do in that situation. The issue with overtreating a low blood sugar is that you then have to treat the high blood sugar; and back and forth you go. You are stuck in a world between highs and lows, with nothing in between.
Try to stay calm when dealing with a low blood sugar. Use glucose tablets as prescribed and follow the treatment plan for hypoglycemia. Keeping track of your blood sugars daily and monitoring your diet are the best things you can do. The more data you collect, the better off you will be in the long run.
How much does 1 gram of sugar raise blood glucose
Each person is different in regard to how much insulin is produced by the body to break down glucose. This amount varies greatly between type 1 and type 2 diabetics, so it is hard to say exactly how much 1 gram of sugar will raise blood glucose levels. Generally speaking, 1 gram of sugar raises blood glucose levels by 5mg/dL. Meaning if you check your blood sugar and it reads 105 mg/dL, then you ingest 1 gram of sugar and recheck 15 minutes later, then it would read 110 mg/dL. It is important to work with your healthcare team to make changes needed to reach your blood sugar goals. Remember, the “1 gram of sugar rule” does not apply to children with diabetes.
Treating a low when blood sugars are variable
So how do you treat low blood sugars when your blood sugar levels are all over the chart? Your levels are extremely high one meal and then extremely low the next meal, and so on and so forth. This may be difficult to manage at first, but keeping a diabetic journal will help. Once you track your blood glucose levels, along with what you eat and how much medication you take, you will begin to see patterns in your body’s responses. Make sure to show your health care provider your diabetic journal, so that they may make changes in your medication regimen.
Often times, too much insulin may be given and needs to be adjusted. Or perhaps you always eat a small dinner, therefore, not as much dinner time insulin is needed. Being a diabetic is not a “one size fits all” disorder. It is customized to your life and lifestyle, but it is up to you to collect the data needed for members of your healthcare team to help you along the way. Make sure you are not adjusting medication doses, even when your blood sugars are variable. Instead, write down what you have found and call your healthcare provider to discuss safe options.
What to do when you are low before an injection
Some people that have lived with diabetes for years will know exactly what to eat in order to counteract their insulin regimen or can tell you exactly how many units they need in order to counteract the food the are about to ingest. This does not come quickly, but instead took years of trial and error, and I guarantee many episodes of hypo-and- hyperglycemia.
Managing diabetes is like trying to juggle knives on a tightrope. So many working parts exist with barriers to successful outcomes along the way; and not without some mistakes being made. Generally speaking, if you are low before an injection, you should follow the treatment for hypoglycemia steps until blood sugar levels are above 70mg/dL. You must understand how to best coordinate your meal and medication routines. Always contact your healthcare provider for questions about skipping or changing insulin doses. Your healthcare team is the best source for information regarding concerns or questions related to your diabetes.
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American Diabetes Association (2017). Checking your blood glucose. Retrieved from: www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose- control/chekcingyour-blood-glucoses.html.
American Diabetes Association (2019). Diabetes technology: Standards of medical care in diabetes. Diabetes Care; 42
American Diabetes Association (2018). Glycemic targets: Standards of medical care in diabetes. Diabetes Care: 41: S55.
American Diabetes Association (2018). Tight diabetes control. Retrieved from:
The Center of Disease Control and Prevention. Manage blood sugar. Retrieved from: https://www.cdc.gov/diabetes/managing/manage-blood-sugar.html
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Know your blood sugar numbers: Use them to manage diabetes. Retrieved from: www.niddk.nih.gov/health- information/diabetes/overview/managming-diabetes/know-blood-sugar-numbers.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Low blood glucose. Retrieved from: information/diabetes/overview/preventing-problems/low-blood-glucose- hypoglycemia