What to eat to correct a low

The ones that contain glucose as such and carry no fat. Glucose tablets, glucose dissolved in water and ordinary sweetened drinks raise glucose within 10 to 15 minutes [1]. Fruit juice raises glucose more slowly [1] [2]. Sugar dissolved in water works almost as well, with a small delay, because it first has to be split into glucose and fructose.

Honey can be used, but it is not the first choice, because its glucose and fructose content varies. Fructose does not raise glucose directly. It does so only after the liver turns it into glucose, over several hours [3] [4]. The glycemic response depends on the amount of glucose in the food, not on the total carbohydrate. Watch the form of the food as well. A solid food, one rich in fat or one rich in fiber, leaves the stomach more slowly, and the correction is slower, as the figure below shows.

Yes, for three practical reasons. The dose is printed on the pack, so you estimate nothing. They do not spoil and they survive for years in a pocket or a bag. On top of that they are not tempting, so you do not eat them for other reasons.

Ordinary foods work, but they bring two problems. You do not know exactly how much carbohydrate you have taken, and the good taste often leads you past the amount you need. Tablets solve both. Glucose in a measured form, as a tablet or a solution, corrects a mild low efficiently with 15 g of carbohydrate [1].

About 150 ml of orange juice, which is a small glass, contains 15 g of carbohydrate. Juice, however, raises glucose more slowly than the same amount of glucose, so tablets remain the first choice [1] [2]. Fruit juices generally carry between 9 and 11 g of carbohydrate per 100 ml. Check the label once and remember the amount for the juices you usually drink.

Watch the packaging. A small 330 ml bottle already holds more than 30 g of carbohydrate, twice what a low needs. If you drink the whole bottle, your glucose will very probably climb above the value you want. Pour it into a glass or buy smaller packs, so that you do not waste time estimating during an episode.

Because of the fat. Chocolate carries a lot of fat, and fat slows the stomach down. The glucose then reaches the blood later, sometimes after an hour, so it does not solve the problem within the 15 minutes that count [6].

There is a second trap. Chocolate tastes good, so people generally eat more of it than they need. The usual result is a prolonged low followed by a high. Keep chocolate for pleasure, not for treating hypoglycemia.

Yes, and this is why the choice of food matters so much. Added fat slows the glycemic response down and then stretches it out. The effect is very clear with chocolate, wafers and ice cream.

There is a second, slower effect. Very fatty meals reduce insulin sensitivity for a few hours, so glucose can climb above the value you want later on [7]. In a low you need a fast and predictable rise, not a delayed and prolonged one.

No. Protein is not used to treat a low. The main reason, which holds in type 1 diabetes, is that protein does not raise glucose quickly. Its effect comes from glucose production in the liver, which starts only after at least an hour and then stretches over several hours [8].

In the forms of diabetes where your own insulin secretion is preserved, protein also triggers an immediate release of insulin from your own pancreas. That makes the low worse. In practice, yogurt, cheese or ham cannot be considered as treatment for a hypoglycemic episode. Milk does contain carbohydrate, so it helps in part, but it acts too slowly. After the correction, if you still have active insulin, choose a snack with slowly absorbed carbohydrate, such as bread, milk or a piece of fruit [2]. Cheese and ham contain almost no carbohydrate, so they do not prevent your glucose from dropping again [8].

Yes, especially in certain situations. The gel is swallowed without chewing, so it is useful in small children, in patients without teeth and when the mouth is dry. To give it you squeeze the tube gently, even if your hands are shaking.

Glucose gel does have a shorter shelf life than tablets. Check the expiration date from time to time and replace the tubes that have stayed too long in the car or in a backpack. Do not forget the rule that glucose gel is given only to a conscious patient who can swallow [2].

A tube of glucose tablets or two packets of gel, plus the meter. That is the minimum kit for a low and it fits in any pocket. Try to add the glucagon your doctor prescribed as well, together with written information on how to give it [5].

The rule that makes the difference is keeping several stashes. Keep something in your bag, in the car, at the office and by the bed. Check once a month that the supplies are still there and have not expired. A low with no treatment within reach can quickly become very dangerous.

No. Drinks with sweeteners contain no carbohydrate, so they do not raise glucose at all [9]. This is a common mistake, especially when the bottle with sugar and the one without look alike. The label is the only thing that tells them apart for certain.

Check the label when you buy and keep the emergency supply apart from the other drinks. Keep a small bottle of ordinary juice or of a normally sweetened drink at home, clearly marked. Bear in mind that during a low you will not be able to read a label carefully.

Yes. Liquids leave the stomach faster, so the glucose reaches the intestine, and then the blood, earlier. After a glucose drink, blood glucose starts to rise in about eight minutes [10]. A glass of juice generally acts faster than a bar or a few cookies.

The difference is a few minutes, but it counts in a low. Glucose tablets come close to the speed of liquids, because they dissolve quickly and are pure glucose. If you have a choice and your glucose is falling fast, pick the liquid form or the tablets.