Highs and lows happen—even with a great plan. Knowing your moves ahead of time keeps you safe and in control.
What to know
- Hypoglycemia (low blood sugar): usually <70 mg/dL (3.9 mmol/L).
- Symptoms: shakiness, sweating, fast heartbeat, confusion, irritability; severe lows can cause fainting or seizures.
- Causes: too much insulin/secretagogues, missed meals, extra activity, alcohol.
- Hyperglycemia (high blood sugar): persistent readings above target.
- Causes: illness, stress, missed meds, carb-heavy meals, pump/infusion issues.
- Emergencies:
- DKA (often Type 1): high glucose + ketones + illness or missed insulin—nausea, vomiting, abdominal pain, fruity breath, deep breathing. Needs urgent care.
- HHS (often Type 2): very high glucose, dehydration, confusion—medical emergency.
Take action
- Treating lows (Rule of 15):
- Take 15 g fast carbs (e.g., 4 oz juice, 3–4 glucose tablets, 1 tube glucose gel).
- Recheck in 15 minutes; repeat if still low.
- Eat a longer‑acting carb/protein if next meal is >1 hour away.
- Preventing lows:
- Match insulin/meds to meals and activity; carry glucose tabs; review recent patterns with your care team to adjust doses.
- Limit alcohol or always pair it with food; check overnight if you had intense exercise late.
- Addressing highs:
- Hydrate; take correction insulin per plan if you use rapid‑acting insulin.
- Walk 10–15 minutes if safe and no ketones present.
- Check for ketones if glucose is >250 mg/dL (13.9 mmol/L) and you have Type 1, are ill, or symptoms suggest DKA.
- Sick‑day basics:
- Never skip basal insulin; check glucose more often; sip fluids; monitor ketones per plan.
- Call your clinician for persistent vomiting, large ketones, or glucose that stays >300 mg/dL (16.7 mmol/L) despite corrections.
Talk to your doctor about
- Your personalized hypo treatment plan and when to use glucagon (nasal or injection).
- Correction factors for highs and when to recheck.
- Sick‑day rules, ketone testing, and when to go to urgent care/ER.
Quick glossary
- Glucagon: rescue medicine that raises blood sugar during severe hypoglycemia.
- Ketones: acids made when the body burns fat; high levels can signal DKA.
- Correction dose: extra insulin to bring a high glucose down to target.
Safety note
Severe symptoms (confusion, fainting, seizures), large ketones, or signs of DKA/HHS are emergencies—seek immediate medical help.