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The Trash Panda’s Guide to Low Blood Sugars (and How to Do Better) - The Diabetes Link

Written by Rachel Halverson BSN RN CDCES NC-BC | Aug 4, 2025, 4:00:00 AM

We’ve all been there: your heart is pounding through your chest, legs feel like they’re ready to give out, and you…can’t feel your tongue for some reason? Your brain is so fogged up, you demolish an entire box of Fruity Pebbles and a jug of Hershey’s Syrup with zero memory of getting to the kitchen. 

Hypoglycemia (low blood sugar) is as much a part of diabetes as are carb counting and taking your medications. 

But someone taught you how to treat it when you were A) too young to remember or B) sprung out in the ICU with an insulin drip. You could hardly remember your date of birth let alone what the heck the Rule of 15 is (it’s a band, right?)

So here’s a review for you, friend: a practical, judgment-free guide to treating lows like a pro, not a trash panda (but if that’s your style, fine). 

The Rule of 15(ish): How Much to Take When You’re Low

If you weren’t in the worst mood when the diabetes educator came into your hospital room upon diagnosis, you might remember them mentioning “the rule of 15.” 

This is a great way to remember what to do when you are hypoglycemic (a blood sugar below 70 mg/dL, or having low symptoms) 

    1. Take 15 grams of fast-acting carbohydrates. 
    2. Wait 15 minutes and recheck your blood sugar. 
    3. If your blood sugar is still below 70 mg/dL, eat 15 more grams of fast-acting carbs and check again in 15 minutes.1

Troubleshooting Hypoglycemia Treatment

You might think, “I usually go way above target when I do this!” That’s because the rule of 15 predates the use of continuous glucose monitors and automated insulin delivery systems in pumps. So if you’re using one or more of these glorious technological advances, you may need to consider:

  • Changes to blood sugar on a CGM are delayed, so we recommend re-checking your blood glucose on a glucometer or waiting 20 minutes instead of 15 minutes.
  • Rate of change is yet another variable to consider. 
    • If your CGM is showing 80 mg/dL with double arrows down, you may want a couple of extra glucose tablets than if you were 68 mg/dL and steady3.
    • Ask your educator or endocrinologist if you’re interested in learning how to adjust based on trend arrows. 
  • Automated insulin delivery pumps (like Tandem Control IQ, Omnipod 5, MiniMed 780g, and Beta Bionics iLet) suspend your basal insulin long before you ever dip below 70 mg/dL.
    • This means you have much less insulin on board and may need less carbs to correct.
    • Many people find they need around 5-10 grams of carbohydrates when using this type of insulin pump. 
  • Another factor is body weight: 
      • The bigger you are, the more carbohydrates it takes to raise the blood sugar. 
      • Increased blood volume in larger individuals increases the need for more glucose to treat a low.
      • If you’re treating a child – you may find 15 grams often overshoots target range.2

What counts as a low treatment? (and what doesn’t)

Our goal when low is to raise blood sugar quickly and predictably. 

The starting point: 15 grams of fast-acting carbohydrates.

Juice box vs glucose tablets. You’d assume they’re the same.

And you’d be wrong!

The body breaks down glucose in your mouth first. Your saliva contains the enzymes responsible for breaking down carbohydrates into glucose, which your bloodstream immediately absorbs.3

Fast-dissolving things, such as glucose tablets, work best here. A juice box or regular soda works well most times, but it ends up in your stomach where the carbs stop digesting and it’s broken down more slowly compared to the tabs. 

Think easier to digest = faster blood sugar response. 

Things like chocolate, peanut butter, trail mix, and pizza contain fat and protein and therefore take a much longer time to digest and break down into glucose. Save these for later – not as low treatments. 

What if I’m REALLY low?

Under 55 mg/dL and feeling like the world is ending? 

Here’s the game plan:

    1. Start with 20-30 grams of fast-acting carbs
    2. Consider glucagon use if
      1. You cannot swallow solids or liquids
      2. You are vomiting
      3. You’ve retreated multiple times, and blood sugar will not rise above 55 mg/dL. 
    3. Wait 15-20 minutes and recheck your blood sugar. 
    4. Follow the rule of 15 again.4

Once you’re back on earth, now what?

Phew — you made it back in range. Consider a follow-up snack depending on:

  • How long until your next meal?
  • Do you have insulin on board?
    • Or did your pump suspend insulin when it predicted the low you just had?
  • Are you about to go run a marathon (maybe don’t)?

If you have a decent amount of insulin on board, aren’t planning on eating in the next couple of hours, or are preparing to be active or were just active, treat yourself to a post low snack!5

Now is the time for protein and fat (finally). These macronutrients help to stabilize your blood sugar from either going too high or dropping low again. Some snacks to consider:

  • Peanut butter crackers (or just a nice spoonful of PB)
  • Half a sandwich
  • Cheese and fruit
  • Yogurt

So you ate the entire pantry (again)

You’ve heard it a thousand times—from your endo, your diabetes educator, and your mom: do not over-treat your low.

Great idea. But they’ve clearly never tried to sit quietly and nibble on four glucose tablets while a hypoglycemia demon inside your brain is screaming at you to eat every carb in sight. Fruity Pebbles? Gone. Sour Haribos? Don’t even remember opening them.

Here’s what to keep in mind if the trash panda wins:

  • You’re OK. Seriously. You’re human. It happens.
  • Give yourself a beat. Let your blood sugar get back into the safe zone before doing anything else.
  • Do NOT rage bolus. That massive correction dose? It might just send you right back into the low spiral.
    • It’s entirely possible your body needed that extra glucose. Don’t assume you overdid it just because you’re high now.
    • If you’re going to correct, wait until you’ve been stable for at least 15 minutes. Then bolus for some of the extra carbs.
    • On an automated pump? Even better. Let it handle it, or log your snack and correct it if the pump algorithm recommends it. 
  • Mantra: My blood sugar will come back down. It always does. Those Fruity Pebbles were worth it. 

One last thing: hypoglycemia is a part of diabetes

Dropping low doesn’t mean you messed up. It means you live in a body with a chronic condition that sometimes takes the wheel and drives straight into the wall. 

So, the next time you find yourself halfway into a bag of gummy bears wondering if your pancreas is plotting against you: breathe, treat, and carry on.

References

  1. Low Blood Glucose (Hypoglycemia) | ADA. Accessed June 19, 2025. https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose
  2. Treating Hypos: One-Size Does NOT Fit All! DiaTribe. June 13, 2013. Accessed June 19, 2025. https://diatribe.org/diabetes-management/treating-hypos-one-size-does-not-fit-all
  3. Digestion and Absorption of Carbohydrates. Medicine LibreTexts. June 3, 2018. Accessed June 19, 2025. https://med.libretexts.org/Under_Construction/Purgatory/Book%3A_Human_Nutrition_1e_(University_of_Hawaii)/04%3A_Carbohydrates/4.02%3A_Digestion_and_Absorption_of_Carbohydrates
  4. Aleppo G, Laffel LM, Ahmann AJ, et al. A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes. Journal of the Endocrine Society. 2017;1(12):1445-1460. doi:10.1210/js.2017-00388
  5. Scheiner G. Take A BITE Out of Hypoglycemia. Diabetes Self-Management. Published online December 2005:7.

 

This resource is supported by Xeris Pharmaceuticals, Vertex Pharmaceuticals, and Dexcom. The Diabetes Link maintains editorial control over content.
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