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Lori Berard, RN, CDE

Definition of Hypoglycemia

Hypoglycemia occurs when blood glucose (sugar) levels drop below normal, typically defined as under 70 mg/dL (3.9 mmol/L) for individuals with diabetes. Because glucose is the primary energy source for the brain

Emergency Action: The 15-15 Rule

If a person is conscious and can safely swallow, treat mild-to-moderate hypoglycemia using the 15-15 Rule:

  1. Consume 15 grams of fast-acting carbohydrates:

    • 4 ounces (1/2 cup) of fruit juice or regular soda (not diet)

    • 3 to 4 glucose tablets

    • 1 tablespoon of sugar, honey, or syrup

    • 5 to 6 hard candies

  2. Wait 15 minutes and check blood sugar again.

  3. Repeat if blood sugar remains below 70 mg/dL.

  4. Once blood sugar returns to a safe range, eat a small meal or snack (such as half a sandwich or peanut butter crackers) to keep levels stable.

Dr. Ronald Goldenberg, MD, Clinical and Research Endocrinologist

Endocrinologist, discusses Preventing and Treating Hypoglycemia.

Key Causes

Hypoglycemia is most common in people with diabetes, but it can occasionally affect others:

  • In People with Diabetes: Taking too much insulin or diabetes medication, skipping or delaying meals, unexpected physical exertion, or drinking alcohol without eating.

  • In People without Diabetes: Severe illness, kidney/liver failure, certain non-diabetes medications, excessive alcohol consumption, or underlying hormonal deficiencies.

Jean-François Yale, Endocrinologist, Montreal

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Psychiatric-Like Symptoms Driven by Hypoglycemia

Low blood sugar can create or worsen several mental health symptoms:

  • Anxiety and Panic Attacks: Adrenaline causes sudden dread, nervousness, heart palpitations, and trembling.

  • Irritability and Agitation (“Hanger”): Deprived of fuel, the brain struggles with emotional self-regulation, leading to sharp mood swings, anger, or low frustration tolerance.

  • Brain Fog & Executive Dysfunction: Low glucose reduces focus, memory retention, and decision-making capacity, often mimicking or worsening symptoms of ADHD.

  • Depressive Slumps: Frequent, chronic glucose “crashes” leave the nervous system depleted, leading to mental fatigue, apathy, and low motivation over time.

The link between hypoglycemia (low blood sugar) and mental health is direct and biological. Because the brain relies almost exclusively on glucose for energy, a drop in blood sugar impairs cognitive function and triggers a stress response that closely mirrors—and often exacerbates—mental health conditions.

The Physiology: Why Low Blood Sugar Alters Mood

When glucose drops below normal levels (typically <70 mg/dL), the brain registers a threat. To keep vital organs functioning, the body releases a surge of stress hormones, primarily adrenaline (epinephrine) and cortisol.

Registered Dietician Andy Desantis

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When approaching nutrition for hypoglycemia (low blood sugar), dietary strategies fall into two main categories: treating an active low blood sugar event and preventing future drops.

1. Treating Active Hypoglycemia: Simple Carbs Only

When blood glucose drops below 70 mg/dL, fast action is needed to raise it quickly.

  • The Rule: Use the 15-15 Rule. Consume 15 grams of simple, fast-acting carbohydrates, wait 15 minutes, and recheck blood sugar.

  • Best Choices: 4 oz (1/2 cup) fruit juice or regular soda, 3–4 glucose tablets, or 1 tablespoon of sugar/honey.

  • What to Avoid During a Low: High-fat or high-protein foods (like chocolate, peanut butter, or ice cream). Fat slows down digestion, delaying the absorption of sugar into the bloodstream when you need it most.

2. Preventing Hypoglycemia: Meal Composition & Timing

To keep blood sugar stable throughout the day and avoid steep drops, focus on how you structure daily meals and snacks:

A. Pair Carbohydrates with Protein, Fiber, and Fat

Eating plain carbohydrates (e.g., fruit alone, pretzels, or toast) causes a rapid spike followed by a steep crash. Protein, healthy fats, and fiber slow glucose absorption, creating a gradual, steady release of energy.

  • Instead of an apple alone: Eat an apple with peanut butter or a handful of almonds.

  • Instead of plain crackers: Pair whole-grain crackers with cheese or hummus.

B. Choose Complex, Low-Glycemic Carbohydrates

Focus on slow-digesting carbs that don’t trigger extreme glycemic volatility:

  • Whole grains (oats, quinoa, barley, brown rice)

  • Legumes (lentils, chickpeas, black beans)

  • Non-starchy vegetables (greens, peppers, broccoli)

C. Maintain Consistent Meal Timing

  • Avoid skipping meals: Extended gaps between meals increase the risk of low blood sugar, especially for those taking insulin or sulfonylureas.

  • Consider planned snacks: A small protein-carbohydrate snack between meals or before bedtime can prevent overnight drops.

D. Be Smart About Alcohol

Alcohol interferes with the liver’s ability to release stored glucose into the bloodstream, significantly increasing the risk of hypoglycemia hours after drinking.

  • Always consume alcohol alongside a meal or snack containing complex carbohydrates.

  • Avoid drinking alcohol on an empty stomach or immediately after intense exercise.