For people with diabetes, monitoring blood sugar levels is a balancing act. In general, diabetes causes higher levels of blood sugar because the body lacks insulin. Without the right treatment, high blood sugar can lead to serious health complications in the long term, including cardiovascular disease, kidney disease, and vision loss.

At the same time, people with diabetes who take insulin as part of their treatment face an increased risk for low blood sugar, or hypoglycemia. This is a serious health concern in its own right, as severe hypoglycemia episodes can lead to seizures or the loss of consciousness.

In the event of a hypoglycemia emergency, a hormone called glucagon can help people with diabetes restore their blood sugar to a healthy range. Here’s what to know about hypoglycemia and the purpose of glucagon in diabetes treatment.

The role of insulin in diabetes treatment

Insulin can help manage both of the two main types of diabetes, type 1 and type 2 diabetes. People with type 1 diabetes, which often begins during childhood or adolescence, cannot produce any insulin at all, so they need insulin injections every day to control their levels of blood glucose.

Type 2 diabetes, which develops gradually due to a mixture of genetic, lifestyle, and environmental factors, involves two key problems with insulin production: cells in the body become resistant to insulin, and the pancreas cannot produce enough insulin to regulate levels of blood glucose. It may be possible to manage early-stage type 2 diabetes with oral medication and healthy lifestyle habits, but many people with more advanced type 2 diabetes take insulin injections to manage their blood sugar.

Insulin must be injected into the fatty tissue under your skin to reach the bloodstream. It may be administered with a syringe, pen, or pump. Read our previous blog for an overview of insulin in diabetes treatment.

Blood sugar targets and insulin reactions

Blood sugar naturally fluctuates throughout the day depending on calorie intake, physical activity, and other factors including stress and sleep. The goal of insulin therapy is to keep your insulin levels as steady as possible to avoid rapid changes in your blood glucose levels. However, blood sugar can fall outside of the healthy range, even with the right dosage of insulin.

An insulin reaction — also referred to as hypoglycemia — is when your blood glucose levels drop below a healthy range after taking insulin. The main causes of hypoglycemia are not eating enough or exercising too much. The timing of your insulin dose can also cause blood sugar to drop.

For many people with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and you may have a different blood sugar target range. Your healthcare provider can help you develop your own targets and determine what too low means for you.

Hypoglycemia symptoms

Individual reactions to low blood sugar vary, so it’s important to take note of your symptoms as they occur and learn your own signs of hypoglycemia. Below are common signs to watch for.

• Shakiness or sweating

• Anxiety, irritability, or impatience

• Feeling sleepy, weak, or lightheaded

• Coordination problems, clumsiness, and confusion

• Fast heartbeat

• Hunger

• Nausea

• Blurred or impaired vision

• Headaches

• Seizures

The only way to confirm that you are experiencing hypoglycemia is to check your blood sugar with a blood glucose meter or a continuous glucose monitor (CGM). However, if you are experiencing signs of low blood sugar and unable to check blood sugar levels, treat symptoms with high-sugar foods or drinks.

The 15-15 rule for treating mild hypoglycemia

Generally speaking, mild hypoglycemia occurs when your blood sugar is between 55-69 mg/dL. It can often be treated by following the 15-15 rule: eat fifteen grams of carbohydrates to restore blood sugar levels to a healthy range and check your levels again after fifteen minutes. If your blood sugar is still below 70 mg/dL or your own personal target, eat fifteen more grams of carbohydrates. Repeat these steps until your blood sugar is back to normal, then eat a meal or snack to maintain it.

Consuming the following items may help raise your blood sugar:

• 3-4 glucose tablets

• 1 dose of glucose gel

• 4 ounces (½ cup) of juice or regular soda (not diet)

• 1 tablespoon of sugar, honey, or syrup

Young children with diabetes typically need less than 15 grams of carbohydrates to raise low blood sugar. If your child has diabetes, work with your healthcare provider to develop an individualized treatment plan.

Severe hypoglycemia and the purpose of glucagon

Severely low blood sugar — 55 mg/dL or less for many people with diabetes — cannot be treated with the 15-15 rule. This is where glucagon comes into play. The purpose of glucagon is to restore blood sugar during these episodes of severe hypoglycemia.

Ideally, working with your doctor to monitor blood sugar levels can help you avoid severe hypoglycemia. However, it’s important to be prepared in the event of an emergency. Glucagon is available by prescription and can be administered as a nasal spray or injection. There are several FDA-approved medication options for glucagon, including GlucaGen®, Eli Lilly’s Glucagon Emergency Kit for Low Blood Sugar, Gvoke®, ZEGALOGUE®, and a generic option approved in December 2020.

 If you have a glucagon prescription, check the expiration date and make sure there’s at least a year of remaining shelf life. Friends, family, co-workers, and anyone else you spend a lot of time with should know where to find your glucagon and how to administer it. Make sure they also know to contact a doctor immediately after emergency glucagon administration.

Blood sugar monitoring and preventing hypoglycemia

Regular monitoring of blood sugar can help you stay within your target range and understand how factors like food, physical activity, medications, and stress affect your blood sugar levels. Depending on your insulin dosage, you may need to check and record your blood sugar multiple times a day, including before and after meals and at bedtime. Your doctor will let you know when to check your blood sugar. It's important to follow the schedule your doctor has recommended and to keep a daily record of your blood sugar levels.

If you find that your blood sugar often falls below your normal range, share your blood sugar numbers with your healthcare provider, along with any relevant information on physical activity and diet. They can help you identify patterns and recommend adjustments to your treatment to keep your blood sugar in balance.

We’re here to support your diabetes care plan

We understand how overwhelming diabetes treatment may feel at first. While health risks like hypoglycemia can be serious, a strong care team can help you stay on top of blood sugar monitoring and confidently manage your diabetes.

Alto is more than just a pharmacy — we’re a partner in your diabetes care. We have a dedicated diabetes support team to ensure that you have everything you need to follow through on your individualized treatment plan. Learn more here or reach out at any time by phone at 1-800-874-5881 or in-app secure messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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