For Low Blood Sugar

For the weekly poll question of May 3-9, I asked for responses to “What I do first if my blood sugar goes too low is,” and listed the following options (the number of responses is shown after each option):

* Use ½ glucose tablet at a time and check BG every 20 minutes (1 response)
* Have a tablespoon of a high-sugar food, like raisins or honey (1 response)
* Have a glass of orange juice (0 responses)
* Lie down and wait until it passes (0 responses)

These were options added by group members:
* Glass of milk (1 response)
* Eat one Starburst then eat a meal as soon as possible (1 response)
* Applesauce or one or two dates (1 response)

Normally, I just post the results of the weekly polls and leave it at that. This one, however, needs some comment. And it’s an excellent example of “conventional wisdom” vs. “present truth.” Okay, I’ll get right to the point.

First of all, the American Diabetes Association (ADA) says low blood sugar (hypoglycemia) is anything under 70 mg/dL. The default setting in my blood glucose meter is 67. Levels below 50 mg/dL affect brain function. So it’s very important to make sure your blood sugar stays in the non-diabetic normal range of 70-90.

What We’ve Always Heard

“Conventional wisdom” says that you should “consume 15-20 grams of glucose or simple carbohydrates, recheck your blood glucose after 15 minutes and repeat if you are still hypoglycemic. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.” Examples of 15 grams include “3-4 glucose tablets, 2 tablespoons of raisins, 4 ounces (1/2 cup) of juice or regular soda (not diet), 1 tablespoon sugar, honey, or corn syrup, 8 ounces of nonfat or 1% milk, hard candies, jellybeans, or gumdrops.” By the way, just one Medjool date has 18 grams of carbohydrate. One-half cup of unsweetened applesauce has 13.7 grams. You may notice that one person above responded that they would eat one Starburst candy, which is actually 4.2 grams of carbohydrate. (One interesting fact about Starburst candies is that they have traditionally contained gelatin made from beef or pork, and only in the last couple of years have started using pectin instead.)

Glucose Tablets Work Faster

“Present truth” (recent, better research, along with simple logic) says that glucose tablets are the best option. Why? Glucose tablets are pure glucose and work faster than anything else. One glucose tablet contains 4 grams and that is always consistent, unlike your choice of a random candy or sugared drink. Sugar (sucrose) is only half glucose and half fructose, which is in itself the second reason to prefer the use of glucose. The trouble with fructose is its impact on our liver. One of the end products is triglyceride, a form of fat. (Here’s an article if you want more details about fructose.) And here is a random diabetic blogger‘s anecdotal post: “Why Glucose Tabs are Better” (http://www.healthcentral.com/diabetes/c/17/74755/glucose-tabs/).

But there’s more.

Glucose Tablets Provide Better Control

Each one gram of glucose ingested will raise your blood sugar 3 to 5 numbers (depending on your size; the smaller you are the more it will raise your blood sugar). But let’s go with 4 for a theoretical average person of 150 lbs. One glucose tablet contains 4 grams of glucose, and thereby will raise your blood sugar 16 numbers. So if you are just barely hypoglycemic at, say, 67 mg/dL, one glucose tablet will raise your blood sugar to 81, or right smack dab to mid-range of normal. A “conventional wisdom” treatment of 15 grams will raise you 60 numbers. Let’s say you were clear down to 50; 15 grams would take you up to 110—not too bad, but certainly above normal range. If you were only down to 70 mg/dL, 15 grams would take you to 130—higher than you’d want to be. Remember, when blood sugar is 140 and above, nerve and organ damage can occur. So, by using multiples of ½ or 1 glucose tablet, you will have much better control over how high your blood sugar goes.

Glucose tablets would be my choice. However, I will say that, since I’ve been following a low-carb high-fat diet and reducing my insulin dosages based on my blood glucose readings, I have not experienced any low blood sugars—hypoglycemic episodes—for a very long time!

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