If you have a meter, check your blood sugar with it: for many people with diabetes, a reading lower than 70 mg/dL is a low, and treating one starts right away, at your desk, without waiting for lunch.
How to tell whether the shaking is a low
Shaking can be a low, and a meter reading tells you whether it is: if you begin to feel even one symptom of a low, check your blood glucose level. The level that counts as low for you might be different from 70 mg/dL, so ask your doctor or health care team what yours is, and if you have no meter, ask them how to check your blood glucose level.
Common symptoms of a low may include shaking and sweating, along with a fast heartbeat, nervousness or anxiety, irritability or confusion, dizziness and hunger. Symptoms tend to come on quickly and can vary from person to person, so learn which ones you get.
A low can also come with no symptoms at all, which is called hypoglycemia unawareness, and a low you cannot feel is harder to treat early, which raises the risk of a severe one. Unawareness is more likely if you have had diabetes for more than 5 to 10 years, often have lows, or take certain medicines, such as beta blockers for high blood pressure. If one of those fits you and you have unawareness, check your blood sugar more often, especially before you drive or exercise.
Why eating less could bring on a low when your medicine is the same
Some diabetes medicines, such as sulfonylureas or insulin, may make your blood glucose drop too low if you skip or delay a meal, and if you don't eat enough carbohydrates, your blood glucose could drop lower than is healthy for you. Eating much smaller amounts than before can mean either of those: a meal you skip or push back, or a smaller plate with fewer carbohydrates on it, while the prescription stays the same.
Insulin can bring on a low as a side effect, and so can some other medicines that help your pancreas release insulin into your blood. Among diabetes pills, sulfonylureas and meglitinides can both cause one, by raising the amount of insulin in your blood. To find out whether your own medicine is one of them, ask your doctor or health care team whether any of your diabetes medicines can cause a low, and how to prevent and treat one.
Other things that can lower your blood glucose include:
- fasting while you still take medicine that lowers blood glucose
- being more active than your usual routine, which can lower it for up to 24 hours afterward
- drinking too much alcohol without enough food
- being sick, when you may not be able to eat as much or keep food down
Leave your medicines as they are for now: make no change to them without talking to your doctor, and for a diabetes medicine that means the doctor who prescribes it. If the lows keep coming, share your blood sugar readings, your medicine routine, your physical activity and how you have been eating with that doctor, who may be able to identify patterns and help prevent lows by making adjustments (see No appetite at all? Start by writing down one day of eating).
Treating a low at your desk before lunch
A reading below 70 mg/dL, or below the level your doctor or health care team told you is low for you, means you treat the low where you are: sugar first, then a wait and a second reading.
- Have 15 to 20 grams of glucose or carbohydrates right away, such as one of the items below; 15 grams is the first step of the 15-15 rule.
- Wait 15 minutes, then check your blood sugar again.
- If you are still below 70 mg/dL, have the same amount again and check after another 15 minutes. Keep repeating these steps until your blood sugar is back in your target range.
- Then eat a balanced snack or meal with protein and carbs. If lunch is more than an hour away, have a snack now, such as crackers or a piece of fruit; if lunch is sooner, it can be that meal.
The sugar needs to be one your body absorbs quickly. Food that is high in fiber, like fruit, beans and lentils, or high in fat, like chocolate and baked goods, can slow down how fast you absorb sugars, so a muffin or a chocolate bar can be a slow way to treat a low. Have one of these with you at your desk, and another at home:
- 4 ounces, or half a cup, of juice, or of regular soda that is not diet
- a tablespoon of sugar, honey or syrup
- hard candies, jellybeans or gumdrops, using the food label to count out 15 grams of carbohydrate
- glucose tablets or glucose gel, used as their own instructions say
With kidney disease, pick apple, grape or cranberry juice over orange juice, which is high in potassium. If one of your diabetes medicines works by slowing how your body digests carbohydrates, a low needs glucose tablets or glucose gel right away, because other sources of carbohydrate, such as juice or candy, will not bring your level up quickly enough. The doctor who prescribes that medicine can tell you whether it works that way.
When a low is more than you can treat yourself
The people with you take over when your blood glucose drops so low that you can't treat it yourself: that is a severe low, which is dangerous and needs treating right away. Depending on your symptoms, you may not be able to use the 15-15 rule, or check your own blood sugar or treat it by yourself.
| How low | What you may feel or show | Who treats it |
|---|---|---|
| Mild to moderate | shaky or jittery, hungry, tired, dizzy, lightheaded, confused or irritable, a heartbeat too fast or not steady, a headache, trouble seeing or speaking clearly | You, with the steps above, for as long as you can check and treat it yourself |
| Severe | unable to check or treat it yourself; more serious symptoms may include feeling weak, trouble walking or seeing clearly, acting strange or feeling confused, losing consciousness or a seizure | The people with you: glucagon if there is a kit they know how to use, then 911 right away, or 911 right away if there is no kit |
A low can also cloud the thinking you need to deal with it: confusion or brain fog could impair your ability to think quickly and make decisions to treat your low. Friends, family, coworkers, caregivers, teachers and anyone else you are often around need to know how to handle a low, which means the signs, how to test your blood sugar and what to do, and if you have a glucagon kit, how and when to use it and where it is kept.
In a severe low, including one that leaves you unconscious or brings on a seizure, the person with you gives you glucagon if you carry a kit and have taught them to use it, then calls 911 right away; with no kit, they call 911 right away. Glucagon is the best way to treat a severe low: it raises blood glucose quickly, is given by injection or as a nasal spray, and your doctor can prescribe it as a kit for an emergency. Ask whoever prescribes your diabetes medicine whether you should keep one, and consider a medical alert bracelet or pendant, which tells other people that you have diabetes and need care right away.
If NicoCares weight care is why you eat less, send your care team a Spruce message about the lows, since Spruce is the secure app where they answer you, and call your diabetes prescriber's office as well, because any change to that prescription comes from them. Replies in Spruce come with no stated time, so treat a low that is happening now at your desk with the steps above instead of waiting on one.
