The core protocol

The 15–15 Rule

The standard protocol for conscious patients who can swallow safely

1

Eat 15g fast carbs

Juice, glucose tablets, regular soda or sugar. See the food list below.

2

Wait 15 minutes

Do not eat more. Sit down and rest while your blood sugar rises.

3

Recheck blood sugar

If still below 70 mg/dL, repeat step 1. If above 70, eat a small snack.

4

Eat a small snack

Once above 70, eat crackers with peanut butter or half a sandwich to keep sugar stable.

If blood sugar does not improve after two full cycles of the 15-15 rule, or if symptoms worsen, seek emergency medical help immediately.

Severity levels

Recognise the severity

Mild
Low sugar
54–70 mg/dL (3.0–3.9)
Symptoms
Shakiness / trembling
Sweating
Hunger
Heart palpitations
Dizziness
You can treat yourself. Apply the 15-15 rule — eat 15g fast carbs, wait 15 min, recheck.
Moderate
Needs help
40–54 mg/dL (2.2–3.0)
Symptoms
Confusion / disorientation
Blurred vision
Difficulty concentrating
Slurred speech
Extreme weakness
You may need assistance. Alert someone nearby. Apply the 15-15 rule if you can still swallow safely.
Severe
Emergency
< 40 mg/dL (< 2.2)
Symptoms
Seizures
Loss of consciousness
Cannot be woken up
Unable to swallow
Unresponsive
Do NOT give food or drink. Use glucagon immediately if available. Call emergency services — do not leave the person alone.
Fast-acting carbs

What to eat during a hypo

Each of these contains approximately 15 grams of fast-acting carbohydrates — the right amount for the 15-15 rule:

Fruit juice
150 ml (½ cup)
~15g
Glucose tablets
3–4 tablets
~15g
Regular soda
150 ml — not diet
~15g
Sugar or honey
1 tablespoon
~15g
Hard candies
4–5 pieces
~15g
Sugar packets
3–4 packets
~15g
What NOT to eat

These raise blood sugar too slowly for an emergency:

Chocolate or candy bars
Biscuits or cookies
Fruit (whole)
Diet or sugar-free drinks
Nuts or cheese
Ice cream
Emergency medication

When to use glucagon

Glucagon is an emergency medication (injection or nasal spray) that raises blood sugar rapidly when a person cannot eat or drink safely. Use it when someone is unconscious, having a seizure or cannot swallow.

Ask your doctor about keeping a glucagon kit at home. Make sure your family knows how to use it.

1Call emergency services (112 / 911) — do this first.
2If glucagon kit is available, administer it now — injection in thigh or buttock, or nasal spray.
3Place the person on their side (recovery position) to prevent choking.
4Once conscious and able to swallow, give them a fast-acting carbohydrate and a snack.
5Do NOT leave the person alone. Stay with them until emergency services arrive.
Prevention

How to prevent hypoglycemia

Don't skip meals

Eat regular meals and snacks. Never skip a meal after taking insulin or diabetes medication.

Monitor regularly

Check your blood sugar before and after exercise and before driving. Use a CGM if available.

Adjust for exercise

Exercise lowers blood sugar. Eat a carbohydrate snack before intense activity and recheck after.

Carry fast carbs always

Always carry glucose tablets, juice or sugar with you — in your bag, car and desk.

Tell people around you

Make sure family, friends and colleagues know you have diabetes and what to do in a hypo.

Review your medication

If hypos are frequent, talk to your doctor — your insulin dose or timing may need adjusting.

FAQ

Frequently asked questions

Eat or drink 15 grams of fast-acting carbohydrates, wait 15 minutes, then recheck your blood sugar. If it is still below 70 mg/dL (3.9 mmol/L), treat again with another 15g. Repeat until above 70 mg/dL, then eat a small snack to keep blood sugar stable.

Mild: shakiness, sweating, hunger, dizziness, palpitations. Moderate: confusion, blurred vision, slurred speech, weakness, irritability. Severe: seizures, unconsciousness, inability to swallow or respond. Symptoms can appear suddenly — always carry fast-acting carbs.

Fast-acting carbs: 150ml of fruit juice or regular soda, 3–4 glucose tablets, 1 tablespoon of sugar or honey, 4–5 hard candies, or 3–4 sugar packets. Avoid fat-containing foods like chocolate during a hypo — fat slows sugar absorption.

Call emergency services immediately if the person: loses consciousness or cannot be woken up, has a seizure, cannot swallow safely, does not improve after two full 15-15 rule cycles, or if you are unsure about their safety. Never leave an unconscious person alone.

Glucagon is an emergency medication (available as an injection kit or nasal spray) that raises blood sugar rapidly when a person is unconscious or cannot swallow. It should be part of every insulin-dependent diabetic's emergency kit. Even after using glucagon, call emergency services and have the person eat carbs when conscious.

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