Blood Sugar Crash: Symptoms and What to Do

What does a blood sugar crash feel like?

Low blood sugar triggers a counter-regulatory stress response as the body tries to protect the brain. The ADA defines hypoglycemia as blood glucose below 70 mg/dL, with clinically significant hypoglycemia occurring below 54 mg/dL 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness. Common symptoms include:

• Shakiness or trembling
• Sweating, especially a cold sweat
• Rapid heartbeat or palpitations
• Sudden hunger
• Dizziness or lightheadedness
• Irritability or anxiety
• Pale skin
• Difficulty concentrating or mental fogginess
• Headache

As blood sugar drops further, more serious symptoms appear: slurred speech, confusion, blurred vision, clumsiness, and in severe cases, seizure or loss of consciousness 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness. Some people — especially those with long-standing diabetes or frequent low episodes — lose early warning symptoms entirely, a dangerous condition called hypoglycemia unawareness 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness.

What causes blood sugar to crash?

Hypoglycemia is most common in people taking insulin or sulfonylureas and similar medications that stimulate insulin release 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Diabetic Kidney Disease.Context on diabetes complications including hypoglycemia causes, alcohol as a trigger, and reactive hypoglycemia in people without diabetes. Common triggers include:

• Skipping or delaying a meal after taking medication
• More physical activity than planned without adjusting food or medication
• Drinking alcohol, particularly without food
• Accidentally taking too much insulin or medication
• Illness or changes in how medication is absorbed

Low blood sugar also occurs in people without diabetes. Reactive hypoglycemia — a drop in glucose a few hours after eating — can affect some people and warrants a clinical evaluation if it is recurrent 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Diabetic Kidney Disease.Context on diabetes complications including hypoglycemia causes, alcohol as a trigger, and reactive hypoglycemia in people without diabetes.

What should you eat immediately for a blood sugar crash?

The ADA recommends the 15-15 rule for mild to moderate hypoglycemia 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness:

1. Eat or drink 15 grams of fast-acting carbohydrates right away. 2. Wait 15 minutes. 3. Recheck blood sugar. If still below 70 mg/dL, repeat. 4. Once blood sugar is back above 70, eat a small snack or meal if the next scheduled meal is more than an hour away.

15 grams of fast-acting carbohydrates means: - 4 glucose tablets (follow package directions) - 4 ounces (half a cup) of regular fruit juice - 4 ounces of regular (not diet) soda - 1 tablespoon of sugar or honey dissolved in water

Avoid high-fat foods like chocolate, peanut butter, or cheese — fat slows glucose absorption and delays recovery. Avoid over-correcting with large amounts, as that drives blood sugar too high and creates a new problem 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness.

When is a blood sugar crash an emergency?

Call 911 or seek emergency care immediately if 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness: - The person cannot swallow safely or is unconscious - The person is having a seizure - Symptoms do not improve after two rounds of the 15-15 treatment - The person is severely confused and cannot treat themselves

For people who use insulin, a glucagon kit (injectable or nasal glucagon) can raise blood sugar when the person cannot eat or drink. The ADA recommends that glucagon be prescribed for all individuals taking insulin or at high risk for hypoglycemia 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness. Make sure people around you know how to use it.

How do I prevent blood sugar crashes?

Prevention depends on understanding your individual pattern 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Diabetic Kidney Disease.Context on diabetes complications including hypoglycemia causes, alcohol as a trigger, and reactive hypoglycemia in people without diabetes:

• Eat on a consistent schedule and do not skip meals, especially after taking diabetes medication; for people with type 2 diabetes this fits within a broader diabetes eating pattern.
• Check blood sugar before exercise and carry fast-acting carbs with you.
• Be careful with alcohol. Alcohol suppresses the liver's ability to release glucose and can cause delayed hypoglycemia hours after drinking 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2023).Diabetic Kidney Disease.Context on diabetes complications including hypoglycemia causes, alcohol as a trigger, and reactive hypoglycemia in people without diabetes.
• Review your medications with your clinician if you are having frequent lows — dose or timing may need adjustment.
• Carry fast-acting carbohydrates when away from home.

If you have had more than one episode in the past few weeks, that is a clear reason to contact your clinician. Frequent lows indicate your treatment plan needs review.

What does a Gale clinician do for recurring low blood sugar?

A Gale primary care clinician can review your medication regimen, eating patterns, and activity levels to identify what is driving the lows. They can check whether your glycemic targets are appropriate for your situation and refer you to an endocrinologist or certified diabetes care and education specialist if ongoing management would benefit from specialist input 1Ref 1American Diabetes Association Professional Practice Committee (2024).6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024.Definition of hypoglycemia (below 70 mg/dL; clinically significant below 54 mg/dL), the 15-15 rule for treatment, glucagon prescribing for insulin users, and hypoglycemia unawareness.