What counts as a hypo
A hypo is blood glucose low enough to impair you. The working threshold is 70 mg/dL, but the number that matters more is which of three levels you are in — because the response is different at each.
| Level | Glucose | What it means | Response |
|---|---|---|---|
| Level 1 | 54–70 mg/dL | An alert value. You can still think and act for yourself | Treat now |
| Level 2 | Below 54 mg/dL | Clinically significant. Judgement is measurably impaired | Treat immediately |
| Level 3 | Any level with impairment | You need another person’s help — confusion, seizure, unconsciousness | Emergency |
Only people on certain medicines get hypos
Hypoglycaemia is a risk if you take insulin, or a sulfonylurea such as glimepiride or gliclazide. Metformin alone does not cause it. If you are on a sulfonylurea and having lows, that is a conversation with your doctor about the drug, not a problem to manage with glucose tablets indefinitely.
How a low announces itself
Symptoms come in two waves. The first is adrenaline, as your body tries to rescue itself. The second is your brain running short of fuel — and by then you are a much worse judge of your own state.
⚡ Early — adrenaline
- Shakiness, trembling hands
- Sweating, clammy skin
- Racing or pounding heart
- Sudden intense hunger
- Anxiety, irritability, a short fuse
- Tingling around the lips
🧠 Later — the brain
- Confusion, difficulty concentrating
- Slurred speech, clumsiness
- Blurred or double vision
- Weakness, dizziness, nausea
- Behaviour that seems out of character
- Drowsiness, then seizure or collapse
Teach two people what you look like
People around you often spot a low before you do — the sudden irritability, the vagueness, the pallor. Tell your spouse, a colleague and a friend what your particular signs are, and tell them explicitly that if they say “check your sugar” and you argue, arguing is itself a symptom.
Test, treat, retest
Three steps, in order. The discipline is in doing exactly this and nothing more, which is far harder than it sounds when you are hungry and frightened.
Test — confirm it with a fingerstick
Symptoms lie in both directions: a fast fall from 300 to 150 can feel exactly like a hypo, and a genuine 55 can feel like nothing at all. If you have a meter, use it. If you genuinely do not have one to hand, treat anyway — the risk of treating a low that was not there is trivial next to the risk of ignoring one that was. A CGM reading lags fingerstick by several minutes, so confirm a low CGM value with blood if you can.
Treat — a measured dose of pure fast carbohydrate
The standard adult dose is about 15 g of fast-acting carbohydrate. Not a snack, not a meal, not whatever is in the fridge — a measured amount of something that is essentially sugar and water. Then stop and wait. This is the hard part.
Wait 15 minutes, then retest
Still below 70? Repeat the same dose and wait another 15. Most lows resolve on the first or second round. Set a timer — 15 minutes feels like an hour during a hypo, and eating through the wait is exactly how a 60 becomes a 280.
Once you are back up, consider a small follow-on snack
If your next meal is more than an hour away, or the low came after exercise, add something with a little protein and slower carbohydrate — a couple of biscuits and milk, a roti, a handful of nuts with fruit. This is about staying up, and it is a separate decision from the rescue itself.
The rebound trap
The overwhelming urge during a hypo is to keep eating until you feel better. But glucose reaches your blood in about 15 minutes and the feeling of recovery lags well behind the number. Eat to the meter, not to the feeling. The 300 mg/dL reading an hour later is not a failure of your insulin — it is the biscuits.
What to treat a low with
Anything that is fast, measurable, portable and does not need chewing. Here is what 15 g looks like in things you can buy in India.
| Option | Roughly 15 g | Notes | Rating |
|---|---|---|---|
| Glucose tablets | 3–4 tablets | Glucovita Bolts, Hypotab and similar. Exact dose, no fridge, fits a pocket | Best |
| Glucose powder | 1 heaped tbsp in water | Glucon-D and equivalents. Cheap, fast, everywhere in India | Best |
| Plain sugar in water | 3 tsp | Always available. Dissolve it — dry sugar is slower and harder to swallow | Good |
| Fruit juice or regular soft drink | 150 ml | Must be the full-sugar version. Check it is not the diet or ‘no added sugar’ pack | Good |
| Honey or glucose gel | 1 tbsp | Useful when someone is drowsy but still swallowing safely | Situational |
| Boiled sweets | 3–4 sweets | Workable if it is all you have, but needs chewing and the dose is vague | Backup |
15 g is an adult average, not a law
How far a gram of glucose moves you depends mostly on your size. For a small child, 15 g is often far too much and produces a 250 an hour later; for a large adult it may not be enough. Work out your own response — treat a low with a measured dose, note where you land 15 minutes later, and you will quickly learn what your personal rescue dose is. Ask your doctor to help you set it, especially for a child.
The things people reach for that make it worse
Fat slows gastric emptying. Anything that combines sugar with fat delivers the glucose late, and delivers a lot of it — which is precisely the wrong shape for a rescue.
Wrong tool for a hypo
Too slow, or too imprecise
- Chocolate — the classic mistake; the cocoa fat delays everything
- Mithai, cake, ice cream — same problem, larger dose
- Biscuits and namkeen — slow, and the dose is unknowable
- A full meal — treat first, eat afterwards if you need to
- Diet drinks — no glucose at all; check the pack
- Alcohol — actively deepens and prolongs the low
Never do these
Safety, not preference
- Never put food or drink in the mouth of someone unconscious — or anyone too drowsy to swallow safely. It is a choking risk
- Never drive while low — or until you have retested and are back in range, plus a settling period
- Never treat a low with insulin — obvious, and it still happens in a confused state; hand the pen to someone else
- Never ignore a low because you feel fine — feeling fine at 50 is the warning sign, not the reassurance
Severe hypos — when someone else has to act
A severe hypo is defined by needing help, not by a number. If the person is confused, unable to swallow safely, fitting or unconscious, oral glucose is off the table.
Recovery position, nothing in the mouth
On their side, airway clear. Do not attempt to feed them, and do not pour juice into an unresponsive mouth. If you have glucose gel, a small amount smeared inside the cheek is safer than anything swallowed.
Give glucagon if you have it
Glucagon tells the liver to release stored glucose, and it works whether or not the person can swallow. In India this is usually a GlucaGen HypoKit, kept at home and in date. It is injected into the thigh or upper arm — the kit includes instructions, and the injection is straightforward.
Call for help — do not wait to see
Call an ambulance on 108, or get to a hospital. If there is no improvement roughly 10 minutes after glucagon, that call cannot wait. If you have no glucagon at all, call immediately — that is the whole plan.
Afterwards — food, then a phone call to the doctor
Glucagon empties the liver’s reserve, so once the person is fully alert and swallowing normally they need carbohydrate to refill it. Nausea and vomiting after glucagon are common. Every severe hypo warrants a call to the treating doctor — something in the regimen needs to change so it does not happen again.
A glucagon kit nobody knows how to use is not a plan
Buy the kit, then spend ten minutes showing your household where it lives and how it works — while you are well, not during an emergency. Check the expiry every few months. The most common reason glucagon fails is that it was expired, or that the only person who understood it was the one on the floor.
Night hypos — the ones you sleep through
Nocturnal lows are the most dangerous kind, for the simple reason that the alarm system is switched off. Many people only discover them through a CGM trace.
Suspect them if you wake with a headache, damp sheets, unusually vivid dreams or nightmares, or a strangely high fasting reading that arrives without explanation — the body can overcorrect a low overnight and leave you high by morning. Chasing that morning high with more basal is exactly the wrong move, and it is a mistake that gets made often.
Know where you are starting from. Your doctor can give you a bedtime threshold below which you take a small snack.
Exercise raises insulin sensitivity for many hours. An evening match or a long walk frequently shows up as a 3 a.m. low, not an 8 p.m. one.
The liver stops releasing glucose while it processes alcohol. A drink at dinner can produce a low well after midnight.
Overnight is where continuous monitoring earns its price — it is the one time of day you cannot check for yourself.
Hypo unawareness, and how to get your warnings back
If you spend enough time low, your body stops raising the alarm. The adrenaline response fades, and the first symptom you notice becomes confusion — which is the point at which you can no longer help yourself.
This is not permanent. Warnings usually return over a few weeks of scrupulously avoiding lows, which normally means agreeing a deliberately higher target with your doctor for a while. Running higher on purpose feels wrong after years of being told to come down, and it is the correct treatment: your alarm system needs the time above range to reset.
Tell your doctor before you tell nobody
Hypo unawareness changes the safety calculation around driving, working at height, operating machinery and living alone. It is worth raising early and directly rather than managing quietly — it is one of the few things in diabetes care with a well-defined fix.
Your hypo kit, and where it lives
A hypo kit that is in the other room is not a hypo kit. Duplicate it, deliberately, in every place you spend hours.
On you, always
Bag, pocket, or both
- Two rescue doses — glucose tablets or sachets, not one
- Glucometer, strips, lancets — a low you cannot confirm is guesswork
- Medical ID — a card or bracelet saying insulin-dependent
- An emergency contact — written down, not only in a locked phone
Stashed elsewhere
The places you get caught out
- Bedside table — for the 3 a.m. low, within arm’s reach
- Car glovebox — and check it survived the summer heat
- Office drawer — plus one colleague who knows about it
- Gym bag — exercise lows arrive fast and often late
- Glucagon at home — in date, and in a place everyone knows
Log every low, even the easy ones
Time, reading, what you had eaten, what insulin you had taken, what you had been doing. Individually each low looks random; four weeks of them almost always reveal a pattern — a particular meal, a particular time, a dose that is a unit too big. That log is what lets your doctor fix the cause instead of treating the symptom.
Build your hypo kit in one order
Glucometers, test strips, lancets and CGM sensors with overnight low alarms — the equipment that turns a hypo from an emergency into a five-minute inconvenience. Free pan-India shipping.
The bottom line
Test, take a measured 15 g of fast carbohydrate, wait 15 minutes, retest. Keep glucose where you actually are rather than where you meant to leave it. Keep glucagon at home and make sure someone else knows how to use it. And write the lows down — the point of treating them well is eventually having fewer to treat.
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