The Rule of 15: Managing Hypoglycemia in Diabetes
Learn how the Rule of 15 helps safely manage low blood sugar in people with diabetes, including practical tips and treatments.
The Rule of 15: A Practical Guide for Hypoglycemia in Diabetes
Hypoglycemia — the clinical term for low blood sugar — is a potentially serious condition that affects millions living with diabetes. When blood glucose falls too low, symptoms such as dizziness, sweating, confusion, and even loss of consciousness can occur. Managing these drops quickly and effectively is essential, and one of the most widely recommended strategies is the Rule of 15.*
What Is the Rule of 15?
The Rule of 15 is a straightforward, stepwise approach developed to treat mild to moderate hypoglycemia in people with diabetes. It involves:
- Consuming 15 grams of fast-acting carbohydrates
- Waiting 15 minutes
- Rechecking blood sugar levels
If blood sugar remains below 70 mg/dL, the process repeats — another 15 grams of carbs, another wait, until glucose rises above the target threshold.
Why Blood Sugar Drops: Understanding Hypoglycemia
To understand the necessity of swift action, one needs to know the causes and dangers of hypoglycemia. Blood glucose is the main energy source for our bodies, supplied by dietary carbohydrates and regulated by hormones, especially insulin. In diabetes, this regulation is disrupted due to insufficient insulin production, insulin resistance, or excessive insulin from medication.
Hypoglycemia can develop in anyone with diabetes (type 1 or type 2), particularly if:
- They take insulin or certain oral diabetes medications
- They skip or delay meals
- They exercise more than usual without adjusting food or insulin
- They consume alcohol
Typically, normal blood sugar is between 90 and 110 mg/dL. When it falls below 70 mg/dL, symptoms can appear,
including:
- Shakiness
- Headache
- Hunger
- Irritability
- Confusion
- Blurred vision
- Palpitations
- Dizziness
- Sweating
When Should the Rule of 15 Be Used?
According to diabetes experts, the Rule of 15 should be used when:
- Your blood sugar is below 70 mg/dL
- You experience symptoms of hypoglycemia, even if you can’t test immediately
Prompt treatment is critical. Left untreated, hypoglycemia can progress to seizures, serious injury, or loss of consciousness.
Step-by-Step: How to Use the Rule of 15
What others are reading
- Check your blood sugar (if possible): If it’s under 70 mg/dL or you suspect it’s low, proceed with the rule.
- Consume 15 grams of fast-acting carbs:
- 4 glucose tablets
- 1 tube of glucose gel
- 1/2 cup (about 4 ounces) of juice or regular (non-diet) soda
- 1 tablespoon of sugar, honey, or corn syrup
- 5 to 6 jellybeans or 5 lifesavers candies
- 3–4 teaspoons of table sugar dissolved in water
Crafting a well-defined plan can significantly mitigate the risks associated with hypoglycemia. For effective strategies and guidance, check out our detailed guide for creating a Hypoglycemic Action Plan. This actionable content can help you prepare for these critical moments with confidence. - Wait 15 minutes. Avoid eating anything else or resuming activity until this period has elapsed.
- Recheck your blood sugar.
- If it’s still under 70 mg/dL, repeat the steps: another 15 grams of carbs, another 15 minutes, recheck.
- Continue until your blood sugar is above 70 mg/dL and symptoms are gone.
- Eat a balanced meal or snack (including protein and carbs) when your blood sugar has returned to a safe level to prevent another drop.
Examples of 15 Grams of Fast-Acting Carbohydrates
| Food or Drink | Serving Equivalent |
|---|---|
| Glucose tablets | 3 to 4 tablets |
| Glucose gel | 1 tube |
| Fruit juice (orange, apple, grape, etc.) | 1/2 cup (4 oz) |
| Regular (non-diet) soda | 1/2 cup (4 oz) |
| Sugar, honey, or corn syrup | 1 tablespoon |
| Hard candies (jellybeans, lifesavers) | 5–6 pieces |
Important: Foods or drinks high in fat or fiber (such as chocolate, candy bars, or whole fruit) are not recommended for rapid correction, as they slow glucose absorption.
Why 15 Grams and Why 15 Minutes?
The Rule of 15 is grounded in clinical experience. 15 grams of carbohydrates is enough to raise blood sugar by about 30–40 mg/dL for most people, which usually brings levels back into a safe target range. 15 minutes is generally how long it takes for the body to absorb these carbs and register the glucose rise in a fingerstick or continuous monitor reading.
Consuming more carbohydrates or eating large quantities at once can backfire, causing blood sugar to spike too high (hyperglycemia), which can set off another medical problem.
Special Considerations for Children
While the Rule of 15 is generally safe for adults and older children, infants and toddlers often require smaller doses. The exact amount should be determined in consultation with a pediatric endocrinologist, since their glucose metabolism and body sizes differ substantially.
What If Symptoms Worsen?
If you or a person you care for shows severe symptoms — such as confusion, unconsciousness, or seizures — and cannot safely swallow or drink, do not attempt to give food or fluids by mouth. In these cases, glucagon is required. Glucagon is a hormone that rapidly raises blood sugar when injected or delivered as a nasal spray, and should be part of any at-risk person’s emergency kit.
- Call 911 or emergency services immediately if someone becomes unconscious or has a seizure from low blood sugar.
- Friends, family, and coworkers of people with diabetes should know where glucagon is stored and how to use it.
How to Prevent Hypoglycemia Episodes
- Eat regular, balanced meals and snacks
- Take diabetes medications as prescribed
- Test blood sugar frequently — especially during illness, increased activity, or changes in medication
- Adjust insulin or carb intake based on exercise and activity
- Avoid drinking alcohol on an empty stomach
- Keep quick sources of sugar (like glucose tablets) with you at all times
When Are You Most At Risk for Lows?
- Hot and humid weather
- During or after exercise
- While traveling or crossing time zones
- When taking new diabetes medications
- During illness (vomiting, poor appetite, infection)
When you expect to be at increased risk, check your blood sugar more often and be especially vigilant for symptoms.
Frequently Asked Questions (FAQs)
What is hypoglycemia, and why does it happen in people with diabetes?
Hypoglycemia is a state where blood glucose drops below normal—usually under 70 mg/dL. In diabetes, it commonly occurs due to too much insulin or medication, skipped or delayed meals, increased physical activity, or alcohol consumption.
How do I know if I am having low blood sugar?
Typical signs include shakiness, sweating, dizziness, hunger, irritability, headache, and confusion. Severe lows may result in seizures or unconsciousness.
Why shouldn’t I eat chocolate or high-fat foods to treat a low?
Chocolate and high-fat foods slow the absorption of carbohydrates, delaying the rise in blood sugar. Fast-acting carbs work quickly and effectively, making them the recommended choice.
How often should I check my blood sugar during a hypoglycemic episode?
After following the Rule of 15, recheck your blood sugar every 15 minutes until levels return safely above 70 mg/dL and symptoms improve.
When should I use a glucagon kit?
Use glucagon if someone cannot safely swallow, becomes unconscious, or has a seizure from low blood sugar. Call emergency services immediately in such situations.
How can I reduce my risk of future lows?
Eat regular meals, match insulin doses to meals and activity, regularly monitor glucose, and always carry fast-acting carbs when out.
Key Takeaways
- Use the Rule of 15 if your blood sugar is under 70 mg/dL or you show symptoms of hypoglycemia.
- Choose fast-acting carbohydrates — glucose tablets, juice, regular soda, simple sugars.
- Wait 15 minutes, then retest, and repeat if necessary.
- After recovery, eat a balanced snack or meal to maintain stable glucose levels.
- Have an emergency plan, including access to a glucagon kit and trained contacts.
- Prevention is key: manage medication, meals, and exercise with vigilance.
*This guide is for informational purposes only. Always seek personalized advice from your healthcare provider regarding your diabetes management plan.
References
- https://ucfhealth.com/our-services/endocrinology/the-rule-of-15-for-diabetes/
- https://www.medicalnewstoday.com/articles/hypoglycemia-rule-of-15
- https://www.cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html
- https://medlineplus.gov/ency/imagepages/19815.htm
- https://www.healthline.com/health/diabetes
- https://www.ncbi.nlm.nih.gov/books/NBK279012/
- https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose
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