Emergency low sugar: What to do if you cannot swallow

First, know what “low sugar” means

• Below 70 mg/dL = Hypoglycaemia.
• Below 54 mg/dL = Clinically significant low sugar.

If possible, confirm with a fingerstick glucose. If you cannot check but symptoms are typical, treat it as low sugar.

Step 1: Decide which situation you are in

You are awake and able to swallow safely

Use the 15-15 rule:

1. Take 15 grams of fast sugar.
2. Wait 15 minutes.
3. Recheck sugar and repeat if still below 70 mg/dL.

Examples of 15 g fast sugar include glucose tablets, sugar, juice, glucose gel, etc.

You are awake, but you cannot swallow fluids properly

Here is the safest, practical approach:

Option 1: Glucose tablets.

• If you can chew and swallow saliva safely, glucose tablets are usually easiest and most predictable.

Option 2: Glucose gel rubbed inside the cheek only if you are fully awake and cooperative.

• If you are alert but cannot drink, a family member can place a small amount of glucose gel between the cheek and gum and gently rub it, allowing it to dissolve slowly.
• Important: this is only for someone who is awake and can protect their airway (can cough, can spit, can follow commands).
• If you are drowsy, confused, choking, or unable to cooperate, do not try this.

Evidence comparing routes of glucose for first-aid treatment exists, but certainty is low, so safety and airway protection matter most.

After the sugar comes up: Once you feel better and can swallow normally, eat a small follow-up snack to prevent another drop, especially if your next meal is far away.

You are confused, having a seizure, or unconscious

This is an emergency.

What family should do:

• Do not give anything by mouth (no water, no juice, no glucose paste) because of choking risk.
• Place the person on their side (recovery position) and call emergency services.
• Use glucagon if available (nasal or injection), as taught by the treating team.

If glucagon is not available, urgent medical help is needed. In hospital, severe hypoglycaemia is treated with IV dextrose.

What to do next

After any significant low sugar episode (especially below 54):

• Tell your diabetes doctor.
• Your insulin or tablet doses may need adjustment.
• Review the common triggers: delayed meals, extra walking/exercise, alcohol, kidney disease, dosing errors, and injection timing.

Quick safety takeaway

• Awake and swallowing safely: 15 g fast sugar, recheck in 15 minutes.
• Awake but cannot drink: glucose tablets if possible; glucose gel in cheek only if fully alert and cooperative.

Confused or unconscious: nothing by mouth; glucagon and emergency help.