MANAGING HIGHS & LOWS
What to do when blood sugar goes off-target — and the math behind correcting a high.
Sometimes blood sugar goes too low or too high. Both situations need quick, calm action. This chapter informs you about how lows and highs are usually managed — how a HypoKit works, when ketones get checked, and how a correction dose is calculated. The exact steps for you are decided together with your medical team and based on your doctor’s recommendations.
🎯 First, know the signs
This chapter is about what to do when blood sugar goes off-target. If you’re not sure how to recognize a high or a low, read Recognizing Highs, Lows & Emergencies first.
Hypoglycemia — when blood sugar drops
Low blood sugar (hypoglycemia) happens to everyone with diabetes occasionally. The trigger is usually too much insulin, a missed meal, illness, or physical activity.
🟢 You’re awake & can eat
Take 15 grams of fast-acting carbs, for example:
- 4 oz (½ small glass) of fruit juice or regular soda
- 3–4 glucose tablets
- 1 tablespoon of honey or sugar
- A few hard candies (check the label — about 15g of carbs)
🔴 Confusion, unable to swallow, seizure, or unconscious
- Severe is defined by how the person is functioning, not by a specific number. It can happen at 54 mg/dL, 60 mg/dL, or any low blood sugar where normal function is impaired.
- If confusion is present, give glucagon first. Oral carbs only if the person is fully alert and cooperative.
- Someone nearby should give glucagon (family member, friend, or emergency staff).
- Call 911 if the person is unconscious, having a seizure, or has any neurologic deficit. If you find someone in this state, call right away — even before giving glucagon if help is needed.
- Don’t try to give food or drink to someone who is unconscious or can’t swallow safely.
After the carbs — the 15/15 rule
Wait 15 minutes
Give the carbs time to work.
Re-check your blood sugar
If it’s still below 70 mg/dL, take another round of fast-acting carbs and wait another 15 minutes.
Eat a regular snack
Once your level is back in range, eat a small balanced snack (carbs + protein) to keep it from dropping again.
If symptoms don’t improve
Call 911 or get to the closest ER.
Your HypoKit (glucagon)
A glucagon kit is your safety net for severe lows. Anyone close to you should know where it is and how to use it.
📦 What’s inside (depends on type)
- Traditional kit (HypoKit, GlucaGen): glucagon powder + syringe with sterile water — needs to be mixed before injecting
- Auto-injector (Gvoke): pre-filled, ready to use — like an EpiPen
- Nasal spray (Baqsimi): single-dose spray in one nostril, no needle
- All come with picture instructions
👥 Who can use it
- You can use it on yourself if still able
- A family member, friend, or bystander can give it
- Designed to be fast and simple in an emergency
- Different brands may look slightly different — check yours ahead of time
🎒 Where to keep it
- With you when you travel — even on short drives
- Easy to reach — not in checked luggage at the airport
- At school or work in a known spot
🧑🏫 Practice ahead of time
- Ask your medical team to walk you through a practice run
- Teach the people you live with how to use it
- Re-check the expiration date a few times a year
Step-by-step instructions and video from the manufacturer
Step-by-step pictures for the traditional injection kit
Royal Children’s Hospital demonstration
Hyperglycemia — when blood sugar runs high
High blood sugar can happen when you’re sick, eat more than usual, or don’t take enough insulin.
📋 What you can do
· Before a meal: add a correction dose to your usual mealtime insulin (see below).
· Gentle activity can help bring blood sugar down — but if you have type 1, check ketones first and only exercise if they’re negative.
· Often running high? Your insulin or medication may need adjusting — talk to your team.
· Check ketones and follow your team’s plan.
Correction factor — the math when you’re high
If your blood sugar is above target before a meal, a small extra dose of short-acting insulin can bring it back down. That extra dose is calculated using your correction factor.
🧮 What’s a correction factor?
It’s a number that tells you how much 1 unit of insulin will lower your blood sugar. Your medical team works it out for you — your job is just to remember it (or save it on your phone).
Check your current blood sugar
Take a reading before the meal.
Subtract your target
Current minus target = how far above target you are.
Divide by your correction factor
That number tells you how many extra units to add.
Add it to your meal dose
Add the correction units on top of your usual short-acting dose for the meal.
📋 Worked example
Note: this is just a calculation example. Your correction factor is individually determined by your medical team and is unique to you.
Ketones — when to test & what to do
Ketones are made when your body breaks down fat for energy because there isn’t enough insulin around. High ketones can lead to diabetic ketoacidosis (DKA) — a life-threatening emergency.
🧪 When to check
- You’re sick — even with a normal blood sugar
- You missed an insulin dose
- Your blood sugar is above 240 mg/dL (13.3 mmol/L)
- You suspect a pump or infusion-set issue
🚨 If ketones are present
What to do is decided by your medical team — they’ll have given you (or will give you) a plan with the exact steps for fluids, extra insulin, and rechecks.
Don’t exercise when ketones are present — physical activity can push blood sugar even higher and speed up DKA.
Call 911 or go to the ER if ketones keep rising despite treatment, ketones don’t clear within 4–6 hours, or you develop belly pain, vomiting, drowsiness, fast or deep breathing, or fever. These are signs of DKA.
More on doses & calculations
University of Iowa Hospitals & Clinics
📌 Before you go
TeenHealthInsight is a health education website — not a substitute for medical advice. Any questions or worries about your medication, devices, or daily care should be brought to your doctor. Learn here, decide there — always loop in your diabetes team before changing anything you do.