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How Do I Reduce My Risk for Low Blood Sugar With Insulin?

How Do I Reduce My Risk for Low Blood Sugar With Insulin?

This article is for people who have type 2 diabetes, their care partners, and others who want to learn more about hypoglycemia (low blood sugar) when taking insulin. The goal is to help you feel more confident about lowering your risk for hypoglycemia.

You'll explore

  • What hypoglycemia is and its signs and symptoms

  • What to do if you're feeling symptoms and when your blood sugar is too low

  • How to lower your risk for hypoglycemia

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What Is Hypoglycemia?

The key for people with diabetes is effectively managing their blood sugars (glucose). Insulin, a natural hormone, processes sugar into energy for the body and brain.

People need to inject insulin because:

  • Their body doesn't make any insulin (type 1)

  • Their body doesn't properly use its own insulin and other medicines may not be enough to manage their blood sugars (type 2)

If you have too much insulin in your body or not enough food for it to process, your blood sugar levels can drop too low. This is hypoglycemia -- when your blood sugar is less than 70 milligrams per deciliter (mg/dL) -- and you need to treat it quickly.

Talk with your healthcare provider about what blood sugar targets and levels are right for you.

How Can I Tell if I Might Have Hypoglycemia?

The early signs of low blood sugar can vary for each person and can change from one episode to the next. If your blood sugar is low, you're likely to feel 1 or more of these symptoms:

  • Shaking

  • Sweating

  • Anxiety or irritability

  • Lightheadedness or dizziness

  • Not thinking clearly, disoriented

  • Hunger

  • Faster heart rate

David Edwards talks about his type 2 diagnosis, and what hypoglycemia feels like to him

Do My Insulin Injections Cause Low Blood Sugar?

If you have type 2 diabetes, insulin can be a powerful medicine to help you manage your blood sugar, but you must balance it with what you eat and how active you are.

Insulin alone does not cause hypoglycemia. Low blood sugar can happen when:

  • You eat less than usual, skip a meal, or don't eat enough carbohydrates (carbs)

  • Are more active than you had planned

What if I'm Feeling the Symptoms of Hypoglycemia?

If you feel you might have low blood sugar, immediately check your levels with a meter. It's important to do this first because even though you may feel like you have a low blood sugar level, you want to make sure before you take steps to treat it.

If your blood sugar is 70 (mg/dL) or lower, you need to bring it up.

What Do I Do If My Blood Sugar IS Low?

If your blood sugar is 70 or lower, follow the "Rule of 15." Eat 15 grams of carbs, then wait 15 minutes and check it again. Be patient and don't overeat. If your blood sugar is still low after 15 minutes, eat another 15 grams of carbs.

Here are examples of 15 grams of carbs:

  • 3 to 4 glucose tablets

  • Half cup of orange juice or regular soda (not sugar-free)

  • 1 tablespoon honey or syrup

  • 1 tablespoon sugar or five small sugar cubes

  • 6-8 candies like Life Savers®

After treatment, eat some protein to provide a later source of blood glucose. This will prevent the blood glucose from dropping too low again.

What Are the Most Important Things to Remember?

Hypoglycemic episodes can be make you feel confused. Yet, it's important to be focused in your treatment so your blood sugar doesn't go too high once you treat it. Keep in mind:

  • Check your blood sugar first, to make sure it really is low

  • Eat 15-30 grams of carbohydrates if it's 70 or lower

  • Wait 15 minutes -- be patient, let the carbs do their job

  • Re-check your blood sugar and only eat more carbs if it's still low

  • Consider following treatment with protein

David checks his sugar first with a meter if he suspects he's having a low episode.

Have a Partner Support You

Because hypoglycemia can make you feel "out of it," it's important to have a family member, a friend, or your significant other who can help you. They should know what the early signs are, how to use your meter to check your blood sugar, and what steps to take if you do have hypoglycemia.

Take your partner with you to meet with your healthcare provider so they can hear what you hear. They can take notes, too, or ask questions.

Some Insulins Help Limit Hypoglycemia

The good news is that some "basal" insulins may help you have fewer hypoglycemic episodes. These are long-acting insulins that help keep blood sugar levels stable, even overnight when you aren't eating. You usually inject them only once a day, and they include:

  • Degludec (Tresiba®)

  • Detemir (Levemir®)

  • Glargine (Lantus®, Toujeo®, Basaglar®)

These medicines, along with knowing how to handle low blood sugar episodes, help you reduce the risk of hypoglycemic episodes.

How Can You Reduce Your Risk?

Keeping the right balance between your medicine and what you eat and when you exercise is the best way to avoid hypoglycemia. To do that, ask your healthcare provider:

  • When and how often should I check my blood sugar?

  • Should I adjust my insulin dose if I know I'll be eating less or being more active?

  • How should I adjust my insulin dose if I'm sick?

  • How do other medicines I may be taking affect my blood sugar?

  • What are the best snacks to have (particularly at night) if I've been more active?

David offers advice about ways to reduce your risk for hypoglycemia.

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Authors and Disclosures


Davida F. Kruger, MSN, APRN-BC, BC-ADM

Nurse PractitionerHenry Ford Health SystemDetroit, Michigan

Disclosure: Davida F. Kruger, MSN, APN-BC, BC-ADM, has disclosed the following relevant financial relationships:Served as an advisor or consultant for: Abbott Laboratories; Dexcom, Inc.; Intarcia Therapeutics, Inc.; Janssen Pharmaceuticals; Lilly; Novo Nordisk; SanofiServed as a speaker or a member of a speakers bureau for: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Dexcom, Inc.; Insulet Corporation; Janssen Pharmaceuticals; Lilly; Novo Nordisk; ValeritasReceived grants for clinical research from: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Dexcom, Inc.; Lexicon Pharmaceuticals, Inc.; Lilly; Novo NordiskOwns stock, stock options, or bonds from: Dexcom, Inc. Ms Kruger does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Ms Kruger does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


Lisa Calderwood, MA

Associate Scientific Director, Medscape, LLC

Disclosure: Lisa Calderwood, MA, has disclosed no relevant financial relationships.


Donald Hannaford

Medical Writer, Rumson, NJ

Disclosure: Donald Hannaford has disclosed no relevant financial relationships.


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