Low blood sugar can be dangerous even when a person with diabetes does not feel warning symptoms. Repeated lows or long-standing diabetes can make symptoms harder to notice, and glucose can fall during sleep. Knowing the low-glucose threshold, how to respond, and when to ask the diabetes care team to review treatment can help reduce the risk.
What counts as low blood sugar?
For many people with diabetes, blood glucose below 70 mg/dL (3.9 mmol/L) is considered low. The American Diabetes Association’s Standards of Care in Diabetes—2026 classify low-glucose events by severity:
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| ADA classification | Glucose level or event | What it means |
|---|---|---|
| Level 1 | Below 70 mg/dL (3.9 mmol/L) and at least 54 mg/dL (3.0 mmol/L) | A low glucose alert level; the person may need to take action under their care plan. |
| Level 2 | Below 54 mg/dL (3.0 mmol/L) | A clinically significant low that warrants attention. |
| Level 3 | An event requiring another person’s assistance, regardless of the measured glucose | A severe event in which the person cannot treat themselves safely. |
These categories do not replace an individual care plan. The level at which a person notices symptoms or needs to act can differ; ask the diabetes care team what threshold and response instructions apply to you.
Why can a low be a hidden danger?
Warning symptoms may be subtle or absent
Possible symptoms include shakiness, sweating, hunger, irritability, dizziness, a fast heartbeat, or confusion. They vary from person to person. Repeated episodes of low glucose or long-standing diabetes can impair awareness, so a person may not recognize a falling glucose level in time to treat it.
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Glucose can fall during sleep
A person who is asleep may not notice symptoms. If lows are happening at night, or a person wakes confused or unwell, record what happened and discuss it with the diabetes care team. Do not assume that no remembered symptoms means glucose stayed in range.
A severe low can prevent self-treatment
Confusion or other severe symptoms can leave someone unable to take treatment or swallow safely. At that point, the danger is not just the glucose reading: the person may need another person to respond.
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Why might someone with diabetes have lows?
Medicines can lower glucose
Insulin is a common cause. Some other diabetes medicines can also cause lows, including sulfonylureas and meglitinides, which stimulate insulin release. Risk depends on the medicine, treatment plan, and the person’s health circumstances; do not change a dose without guidance from the prescriber or diabetes care team.
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Meals, activity, alcohol, and illness can change the balance
- Delaying or skipping a meal, eating fewer carbohydrates than planned, or fasting while continuing glucose-lowering medicine can contribute to a low.
- More physical activity than usual can lower glucose during exercise and for hours afterward.
- Alcohol without enough food can increase the chance of a low.
- Illness that reduces appetite or food intake can affect glucose, especially when a person continues their usual medicines.
Some people have higher risk
NIDDK identifies type 1 diabetes, insulin or certain other glucose-lowering medicines, age 65 or older, previous lows, and conditions such as kidney disease, heart disease, or cognitive impairment as risk factors. These are risk factors, not a prediction that every person in those groups will have a low.
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The size of the problem depends on the population and measure. NIDDK reports that, in a large global study, 4 in 5 people with type 1 diabetes and nearly half of people with type 2 diabetes who take insulin reported at least one low-glucose event in a four-week period; the accessed NIDDK page does not state the study’s publication year. NIDDK also estimates that 2 in 100 U.S. adults with diabetes taking insulin or certain medicines that prompt insulin release may develop severely low blood glucose each year. Separately, the ADA says the average person with type 1 diabetes has symptomatic low glucose up to twice a week; that figure refers to episodes with symptoms, not all measured lows. See NIDDK’s low blood glucose guidance and the ADA’s causes and prevention guidance.
What should you do for a low blood sugar reading?
If the person is alert and can swallow safely
The CDC’s 15-15 rule is intended for treating a low in someone able to take food or drink by mouth: take 15 grams of fast-acting carbohydrate, wait 15 minutes, then check glucose again. If it is still below 70 mg/dL, repeat the treatment and recheck after another 15 minutes. Follow an individualized plan if the care team has given different instructions.
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The CDC lists glucose tablets or gel, juice, regular soda, sugar, honey, and syrup as options. Glucose tablets are a practical item to carry; use the package directions to identify the amount that provides 15 grams. Foods high in fat or fiber can take longer to raise glucose, so they are not the preferred first treatment. Children may need different amounts, which should be discussed with their clinician.
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Do not give food or drink by mouth to someone who is unconscious, having a seizure, or unable to swallow safely. Glucagon is the emergency treatment described by the ADA, CDC, and NIDDK. A caregiver should use it according to the product instructions and the person’s emergency plan, then seek emergency medical help; the CDC specifically advises emergency medical treatment after a glucagon injection. Family members, friends, and other caregivers should know where glucagon is kept and how to use it. The ADA’s symptom and treatment guidance provides further context.
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- 24/7 GLUCOSE TRACKING. See your glucose response to food, exercise, sleep, and other lifestyle factors via the Lingo app.
- OPTIMIZE YOUR NUTRITION. Discover which foods work for you and those that don't. The Lingo app shows you how specific meals and other factors impact your glucose, so you can learn from your insights and build healthier habits
- NAVIGATE PREDIABETES WITH A NEW VIEW OF YOU. More time in healthy glucose range is linked to lower diabetes risk. Three out of four users with prediabetes say Lingo was effective in helping to achieve their health goals¹.
- HEALTHY GLUCOSE SUPPORTS HEART HEALTH. What you eat matters to your glucose and your heart. Keeping your glucose in a healthy range (70–140 mg/dL) more often can help protect your heart from heart disease²⁻⁴.
How can you reduce the chance of future lows?
- Keep a record of glucose readings, symptoms, medicines, meals, activity, and alcohol, especially around episodes. Patterns can help the care team identify contributing circumstances.
- Ask when to check glucose around exercise, changes in routine, illness, or meals that may be delayed. Activity can affect glucose for hours, so ask whether additional checks are appropriate for your plan.
- Carry a fast-acting carbohydrate, such as glucose tablets, so it is available when needed.
- If lows happen often or warning symptoms are impaired, ask whether a continuous glucose monitor (CGM) could help identify lows or provide earlier warning. It is a monitoring tool to discuss with a clinician, not a substitute for an emergency response plan.
In its 2026 standards, the ADA says recurrent level 2 hypoglycemia or any level 3 episode should prompt intervention and reconsideration of the diabetes treatment plan. Bring the glucose and symptom record to the appointment and review medicines, meals, activity, and prevention options with the care team. Do not adjust diabetes medicines on your own.
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