Understanding the Rule of 15 for Diabetes: How to Safely Treat Hypoglycemia
Everything you need to know about the Rule of 15—a step-by-step approach to quickly and safely manage hypoglycemia in diabetes.
What Is the Rule of 15 in Diabetes?
The Rule of 15 is a well-established method used to manage hypoglycemia—a condition marked by low blood sugar (typically <70 mg/dL). Primarily recommended for individuals living with diabetes, this straightforward rule aims to safely and quickly raise blood glucose to a healthy range, minimizing the risks associated with both low blood sugar (hypoglycemia) and an excessive rebound into high blood sugar (hyperglycemia).
According to the American Diabetes Association and leading endocrinologists, the Rule of 15 involves consuming 15 grams of fast-acting carbohydrates, waiting 15 minutes, and then rechecking blood sugar. If your blood sugar remains low, the process is repeated until your levels return to the target range.
Why Does Hypoglycemia Happen in Diabetes?
Hypoglycemia is most common in people with diabetes who take insulin or certain oral medications that increase insulin production. Blood sugar can fall for multiple reasons:
- Taking too much insulin or diabetes medication
- Skipping or delaying meals
- More physical activity than usual
- Consuming alcohol without enough food
- Illness or changes in routine
Normally, the body regulates glucose to remain within a target range (typically around 90–110 mg/dL). When glucose falls under 70 mg/dL, symptoms of hypoglycemia may appear.
Common Symptoms of Hypoglycemia
- Sweating
- Shakiness or trembling
- Rapid heartbeat
- Hunger
- Confusion or irritability
- Dizziness
- Headache
- Slurred speech
- Clumsiness or poor coordination
If left untreated, hypoglycemia can result in severe complications like loss of consciousness, seizures, or even coma.
How the Rule of 15 Works
The Rule of 15 is a step-by-step strategy designed to quickly and safely restore blood glucose without causing dangerous swings in blood sugar levels. Here’s how it works:
- Check your blood sugar as soon as you notice symptoms of hypoglycemia or when your blood glucose monitor reads below 70 mg/dL.
- Eat or drink 15 grams of fast-acting carbohydrates.
- Wait 15 minutes. Allow the carbohydrates to be digested and absorbed.
- Recheck your blood sugar. If still below the recommended range, repeat the cycle (consume another 15 grams of carbs, wait 15 minutes, and check again) until your blood sugar is above 70–100 mg/dL.
- Once your blood sugar returns to normal, eat a small, well-balanced snack or meal if your next meal is more than an hour away.
Why 15 Grams?
15 grams is considered sufficient to raise blood sugar by approximately 30–50 mg/dL in most adults, but not so much that it poses a risk of rebound hyperglycemia. This makes the method safe and effective for most people experiencing mild to moderate hypoglycemia.
Fast-Acting Carbohydrate Options
The key to the Rule of 15 is using fast-acting carbohydrates, also known as high-glycemic index (GI) foods, which are rapidly absorbed and provide a quick boost in blood sugar.
| Fast-Acting Carbohydrate | Serving Size (~15g carbs) |
|---|---|
| Glucose Tablets | 4 tablets (4g each) |
| Glucose Gel | 1 tube (15g) |
| Fruit Juice (orange, apple, etc.) | 1/2 cup (4 oz, not diet) |
| Sugar, honey, or corn syrup | 1 tablespoon |
| Regular soda (not diet) | 1/2 cup (4 oz) |
| Jelly beans | 6 pieces |
| Hard candy (such as Lifesavers) | 5 pieces |
| Gumdrops | See label for portion |
What others are reading
Note: Avoid using high-fat or high-fiber foods, like chocolate, nuts, or beans, as these slow down absorption.
When to Use the Rule of 15
Use the Rule of 15 when blood sugar falls below 70 mg/dL or when you experience mild to moderate symptoms of hypoglycemia. If symptoms include confusion, loss of consciousness, or inability to swallow, immediate medical treatment is required.
- If your blood sugar remains low after repeating the Rule of 15 three times, seek emergency medical assistance.
- If you have frequent low blood sugar episodes, consult your healthcare provider to reassess your diabetes management plan.
Special Circumstances: Severe Hypoglycemia and Glucagon
If you or someone you know experiences severe hypoglycemia (unresponsiveness, unable to ingest food, seizures, or unconsciousness), the Rule of 15 is not sufficient. Glucagon—a hormone that triggers glucose release from the liver—must be used. There are two primary forms:
- Injection: Administered into muscle tissue; caretakers or trained individuals should be prepared to inject glucagon if needed.
- Nasal spray: Inserted into a nostril and administered by pressing the plunger.
After emergency glucagon administration, call for medical help. Instruct family, friends, or coworkers on glucagon kit location and how to use it if you are at risk for severe hypoglycemia.
After Hypoglycemia: What Comes Next?
Once your blood sugar has returned to the target range and if your next meal is more than an hour away, eat a combination carbohydrate/protein snack to help maintain blood glucose stability. Examples include:
- Whole-grain crackers with cheese
- Peanut butter on toast
- Greek yogurt
Additionally, after a hypoglycemic episode, your risk of another episode increases for the next several hours. Be especially vigilant about frequently monitoring your blood glucose, especially if you:
- Are physically active
- Are in hot or very active environments
- Are recovering from illness
- Have experienced recent medication adjustments
Prevention Tips: Reducing Hypoglycemia Risk
Preventing hypoglycemia is an important part of diabetes self-management. Strategies include:
- Eat regular, balanced meals and snacks
- Monitor blood sugar as directed by your healthcare provider
- Adjust medication and insulin based on food intake and activity
- Carry fast-acting carbs at all times
- Inform friends, family, and colleagues about signs of low blood sugar and actions to take
Foods to Avoid During Hypoglycemia
Not every carbohydrate source works equally well when treating hypoglycemia. Avoid eating foods high in fat or fiber, such as chocolate or peanut butter, when treating a hypo episode, as these slow the absorption of glucose and delay recovery. Instead, focus on foods from the quick-acting list above.
Sample Hypoglycemia Treatment Table
| Situation | Treatment |
|---|---|
| Mild symptoms (6le;70 mg/dL) | Rule of 15 with fast-acting carbs, check after 15 minutes |
| Persistent symptoms | Repeat Rule of 15 until blood sugar normalizes |
| Severe symptoms (Unresponsive/Seizure) | Administer glucagon and seek emergency help |
Frequently Asked Questions (FAQs)
Q: Can the Rule of 15 be used for everyone with diabetes?
A: The Rule of 15 is appropriate for most adults and children with diabetes who experience mild to moderate hypoglycemia and can eat or drink safely. For infants, toddlers, the elderly, or those with coexisting conditions, consult your healthcare provider for individualized guidance.
Q: What should I do if I don’t feel better after using the Rule of 15 three times?
A: If symptoms persist or you are unable to raise your blood sugar using the Rule of 15 after three cycles, seek emergency medical help right away. There may be an underlying cause that needs professional intervention.
Q: Why can’t I just eat a candy bar or chocolate?
A: Chocolate and other high-fat foods are absorbed more slowly and do not quickly raise blood sugar. Always use fast-acting carbohydrates for the Rule of 15.
Q: Should I continue my activities/exercise after treating hypoglycemia?
A: Resume activities only after your blood sugar has returned to a safe range (above 100 mg/dL for exercise) and you feel well. Monitor your blood sugar more closely during and after physical activity.
Q: Is the Rule of 15 effective for nighttime hypoglycemia?
A: Yes; however, because hypoglycemia can recur at night, check blood sugar frequently after a nighttime episode and follow up with your healthcare provider if episodes are frequent.
Key Takeaways
- The Rule of 15 is a simple, evidence-based tool to treat low blood sugar by consuming 15 grams of fast-acting carbohydrates, waiting 15 minutes, and retesting.
- Repeat the process until blood sugar returns to normal, then eat a balanced snack if needed.
- Severe hypoglycemia requires emergency treatment with glucagon and immediate medical help.
- Prevention, education, and regular monitoring are critical for optimal diabetes management.
If you have diabetes, keep fast-acting carbs and a blood glucose meter on hand at all times, educate those around you, and work closely with your care team to adjust your management plan as needed.
References
- https://ucfhealth.com/our-services/endocrinology/the-rule-of-15-for-diabetes/
- https://www.medicalnewstoday.com/articles/hypoglycemia-rule-of-15
- https://diabetes.org/health-wellness/fitness/blood-glucose-and-exercise
- https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose
- https://www.healthline.com/health/how-to-raise-blood-sugar-fast
- https://www.healthline.com/health/video/low-blood-sugar-healthy-food-type-1-diabetes
- https://www.healthline.com/health/video/the-complete-guide-to-insulin-and-how-to-use-it
- https://www.uc.edu/news/articles/legacy/healthnews/2006/09/uc-health-line–classes-available-to-manage-deadly-disease.html
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