If you have diabetes, you don’t jus​t have to watch out for high blood sugar. You must watch out for low blood sugar as well.

"Symptoms of hypoglycaemia are unpleasant and may interfere with your daily activities. Serious hypoglycaemia may cause accidents, seizures, coma and death. Fortunately, there are ways to recognise, treat, and prevent hypoglycaemia," says Dr Amanda Lam, Associate Consultant at the Department of Endocrinology, Singapore General Hospital (SGH), a member of the SingHealth group.

be prepared to deal with hypoglycaemia

  • Monitor your blood glucose levels frequently
  • Carry quick-acting carbohydrates with you at all times, so that you are always prepared to treat hypoglycaemia

"Tell your family and friends what symptoms to look out for and what to do, in case you are not able to treat hypoglycaemia yourself," advises Dr Lam.

If you experience low blood sugar symptoms, immediately stop any physical activity and check your blood sugar level with a blood sugar monitor to confirm that it is low. It is recommended to consume a sugary food or beverage, or over-the-counter glucose tablets immediately to raise your blood sugar level. Do not take your diabetes medication until your blood sugar level is normal.

How to treat low blood glucose using the 15/15 rule

Step 1:

If you experience symptoms of hypoglycaemia, check your blood glucose using your glucometer. If your blood glucose is < 4.0 mmol/L, eat or drink 15 g of fast-acting carbohydrates immediately.

Examples of fast-acting carbohydrates include:

What to eat for hypoglycaemia 4-5 glucose tablets, or 

What to eat for hypoglycaemia1/2 can of soft drink (150ml-200ml), or

What to eat for hypoglycaemia1/2 glass of fruit juice (150ml), or 

What to eat for hypoglycaemia 3 teaspoons sugar with half cup water

If you have symptoms of low blood glucose, but cannot check your blood glucose immediately, eat or drink 15g of fast-acting carbohydrates to be safe.

Avoid using these types of foods to treat low blood glucose, as it will take too long to increase your blood glucose levels:

Foods to avoid for hypoglycaemia Any food or drink containing fat or protein

Any item that requires a lot of prolonged chewing/sucking

Step 2:

Wait for 15 minutes, and then re-test your blood glucose.

Wait for 15mins to re-test blood glucose levels

Step 3:

If your blood glucose is still low (< 4.0 mmol/L), repeat steps 1 to 3. If your blood glucose is 4.0 mmol/L and above, proceed to step 4.

Step 4:

Blood glucose levels may fall again about 1 hour after you have treated your hypoglycaemia. If your next meal is more than 1 hour away, eat an additional snack containing 15g of longer-acting carbohydrates.

Examples include:

What to eat for hypoglycaemia 3 pieces of biscuits, or

What to eat for hypoglycaemia 1 slice of bread


Tips to prevent hypoglycaemia

  • Take your diabetes medication regularly as recommended by your doctor.
  • Eat nutritious meals and time them to balance your diabetes medication.
  • Monitor your blood sugar level regularly based on your doctor’s recommendation.
  • Adjust your food intake and medication according to your exercise routine.

When should you go to the hospital?

A family member or friend should take you to the hospital or call an ambulance (995) immediately if you:

  • Continue to have low blood glucose (< 4.0 mmol/L) after repeated treatments with fast-acting carbohydrates
  • Have a seizure
  • Are unconscious because of a hypoglycaemia episode

What is hypoglycaemia?

Hypoglycaemia (low blood glucose) happens when blood glucose falls below normal levels. A blood glucose level of < 4.0 mmol/L is considered hypoglycaemia. Hypoglycaemia may happen to anyone with diabetes, but is more common in people who take insulin and certain types of oral diabetes medications.

If you are on treatment for diabetes, hypoglycaemia may occur when you:

  • Take too much insulin, or certain oral glucose-lowering pills
  • Altering the timings or doses of insulin and other diabetic medication
  • Do not eat enough food
  • Wait too long between meals, or skip a meal
  • Exercise more than usual
  • Drink excessive alcohol, or drink alcohol without food

If you suspect that you may be having hypoglycaemia (low blood glucose), test your blood glucose level using a glucose meter.


Signs and symptoms of hypoglycaemia

Early symptoms of hypoglycaemia

Early signs and symptoms of hypoglycaemia include:

  • Shakiness
  • Sweating
  • Fast heartbeat
  • Headaches
  • Dizziness
  • Tingling sensation in your fingers, lips or tongue
  • Feeling hungry or nauseous
  • Feeling nervous or anxious
  • Feeling irritable

Severe symptoms of hypoglycaemia

Severe symptoms can include:

  • Weakness and difficulty walking
  • Blurred vision
  • Confusion and abnormal behaviour
  • Slurred speech
  • Loss of consciousness
  • Seizures

If you have severe symptoms, you or the people around you should call for an ambulance (995) immediately.

Hypoglycaemia may happen while you are sleeping. Some clues that you may be experiencing hypoglycaemia while asleep include:

  • Profuse sweating while sleeping
  • Seizures
  • Feeling tired or confused, or having a headache after waking up


Ref: L20

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