The Right Number of Carbs for a Low Glucose

It’s easy to panic when you have a low glucose. Your heart is racing, your body is pumping out adrenaline, and your stomach says “Feed me! FEED ME!!!” Your brain isn’t working logically, and if you live alone you may be afraid if you don’t eat that chocolate cake, you might pass out and not wake up.

Lows do not mean unlimited treat time. A panic overdose of orange juice with sugar, a box of chocolates, plus the entire contents of your refrigerator only causes rebound highs and makes your goal of stable blood sugars hard to achieve. Restrain from piling on excess carbs in a ‘binge til you stop shaking’ routine. Your body will also be raising your glucose through a release of stored glucose from the liver. Dual responses from binge eating and the stress hormones affecting your liver only keep you strapped into a rollercoaster.

Box 1. Quick Carbs with 15 Grams
3 BD Glucose Tablets
3 Smartie® Rolls (in cellophane)
4 CanAm Dex4® Glucose Tablets
5 Dextrosol Glucose Tablets
5 Wacky Wafers®
6 SweetTarts® (3 tabs/packet)
7 Pixy Stix
8 SweetTarts® (3/4″ Lifesaver size)
14 Smarties® (3/4″ diameter roll)

If your glucose frequently goes high after lows, you are likely overtreating the low. Wear a CGM and act on the first alert with an immediate intake of quick carbs to eliminate unwanted glucose spikes. If you are having frequent lows, go to Frequent Lows.(link to: Frequent Lows [Pattern 3])

Eat quick carbs quickly to minimize stress hormone response and the chances of your glucose rising sharply afterward. You’ll quickly feel better and your brain, muscles, and cells will thank you for resupplying the fuel that shortens their misery. On an AID or pump that has basal suspend, your basal delivery will have been reduced for some time. This significantly reduces how many carbs you need for treatment.

Core Hypoglycemia Tips:

  • Eat glucose tabs instead of something yummier. Not only do tabs work fastest, but they’re also not as tempted to overeat and they make it easy to track the grams of carb you consume. Smarties or Sweet Tarts, made of glucose or actually dextrose that is two glucose molecules hooked together, are optimal and less expensive options.
  • When the first alert occurs for a low glucose or pending low, treat immediately before it worsens. Speedy treatment reduces stress hormone release and minimizes rebound highs.
  • After a moderate to severe low glucose, wait for 30 to 45 minutes before driving or operating machinery. Coordination and thinking take longer to return to normal than the glucose reading on your meter.
  • If you overeat in a weak moment, calculate the grams of excess carbs you consumed once your brain is working again. Then bolus for them right away to avoid going high. It might feel wrong to bolus when low, but these excess carbs will send your glucose up long before the bolus has any impact.
  • When a low glucose occurs before a meal, treat the low with the right number of carbs but bolus for any additional carbs! Skipped or delayed boluses make the glucose spike and increase the risk of insulin stacking and hypoglycemia at the next meal. Once you consume quick carbs for the low, consider perhaps a slight reduction in the bolus (or injection) to reduce the risk of having another low.
Steps to Determine the Exact Grams of Quick Carbs Needed for a Low Glucose
  1. First, eat one gram of quick carb for every 10 pounds of body weight. That is, a 150 lb. person would eat 15 grams to treat a low glucose. (A small child should eat at least 6 grams.) See Textbox 1 for a list of Quick Carbs.
  2. For excess IOB, add 10 more grams of carb for every unit of IOB to cover this residual insulin activity. For more accuracy, add grams = IOB (units) x CarbF (grams/unit).
  3. After increased activity, more carbs may be needed.
  4. To ensure your glucose has risen, test it 15 minutes later on a meter, or look at your CGM screen after 20 minutes (CGM readings lag behind).

IOB calculations CANNOT be accurate unless your Insulin Action Time (IAT) or Duration of Insulin Action (DIA) time is set to at least 4.5 hours or LONGER!(link to Eliminate-Insulin-Stacking).


Someone who weighs 130 lbs (59 kg) with a glucose at 50 mg/dL (2.7 mmol/L), 2 units of IOB, and a CarbF of 10 (1u/10grams):

  1. 130 lbs = 13 grams
  2. IOB x CarbF = 2 units x 10 grams/unit = 20 grams
  3. 13g + 20g = 33 grams of carbs are needed to treat this low glucose.

Your pump or AID should do this calculation for you!

Quick Versus Not-So-Quick Carbs

The “sugar” in blood is glucose. Dextrose, a double glucose molecule found in Dex4, Glucolift, and BD glucose tablets, and in candies like Sweet Tarts and  Smarties, rapidly resupplies glucose to your body. Glucose and dextrose reach the blood as 100 percent glucose, making them ideal choices for hypoglycemia. Fast-acting glucose tablets and candies with known amounts of carb also reduce the risk of an overdose.

Table sugar, on the other hand, is made of one glucose molecule and one fructose molecule and has only half as much immediate glucose as glucose tabs. Fruit juices, like orange juice, contain a bit less glucose, take longer to raise the glucose, and are frequently over-consumed (If you use juice, use only the small juice boxes!). For serious hypoglycemia, choose the fastest high glycemic food available for a quick rise in glucose and to get back on your feet quickly. Textbox 1 shows examples of glucose sources that contain 15 grams of quick carbs.

Don’t try to figure things out once your brain is in a fog from a low glucose! Prepare:

  • Memorize how many grams you need for rapid treatment.
  • Keep glucose tabs or other quick carbs handy at your bedside, in your pocket or purse, at your desk, in the glove compartment, and where you exercise.
  • Use them automatically and allow time for your glucose to correct before eating more.
  • You’ll be glad later that you didn’t overindulge.

Now you’re ready to start charting your course for smooth sailing. The first step is to Verify your TDD.

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