Not All Sugars Are the Same: Using Glucose to Treat Hypoglycemia

If you could relieve your low blood sugar symptoms more quickly, would you? 

Low blood sugars—also known as hypoglycemia—can be one of the most challenging, stressful and scary parts of living with diabetes. If you take insulin or other blood sugar-lowering medications, learning how to prevent and treat low blood sugars is extremely important.

• Treating low blood sugar: If your blood sugar level is at or below 3.88 mmol/L (70 mg/dL) and you can drink or chew, treat with 15 grams of fast-acting carbohydrates. Wait 15 minutes, check your blood sugar and treat again if it’s still low.
• Severe low blood sugar: If your blood sugar is below 3.0 mmol/L (55 mg/dL) and you are unable to drink or chew fast-acting carbohydrates, someone around you should call 911 and administer emergency glucagon.

Preparing for low blood sugar emergencies

People with diabetes (PWD) are generally told to eat 15 grams of fast-acting carbohydrates when treating low blood sugar. But here’s what most people don’t know: there’s one kind of sugar that works better than others.

While it’s important to be prepared with fast-acting carbohydrate options, many PWD have found themselves relying on not-so-great low blood sugar treatments that may cause more problems than they help.

This guide breaks down the best ways to treat low blood sugar and explains why the right stuff matters.

What’s the best type of sugar to treat lows?

Health care providers (HCPs) often recommend glucose tablets over a bowl of ice cream or even a handful of grapes to treat low blood sugar, for example. This is because the fat and protein in ice cream can slow down the digestion of sugar. The type of sugar in your carbohydrate source also matters when treating lows.

The three main types of sugars found in food are:

• Glucose/Dextrose: Raises blood sugar levels immediately because it is already in the form of sugar that your brain and cells recognize and require for fuel.
• Fructose: Does not break down into glucose and raises your blood sugar because the liver must metabolize fructose.
• Sucrose: Known as a “double sugar” because it’s made of equal parts glucose and fructose, meaning only half of its contents can raise blood sugar.

Let’s look at how each of these sugar types supports you during a low blood sugar.

Using glucose (aka dextrose) for lows

Glucose—also known as dextrose—immediately raises blood sugar levels. Unlike sucrose or fructose, glucose is already in a form your body can use, making it the most rapidly absorbed source of carbohydrate you can choose.

The faster you can raise your blood sugar, the sooner you can calm the uncomfortable (and often scary) symptoms of low blood sugar.

Sources of 100% glucose include: 

• Dex4 glucose tabs
• Glow glucose gummies
• Glucose gel varieties
• Smarties
• Pixie Stix
• Elovate glucose powder

When you choose these sources of carbohydrate to treat a low, your blood sugar will likely rise significantly faster than choosing a piece of fruit, a juice box, a candy bar or even a spoonful of honey.

That being said, some plant-based foods contain more glucose than others, including grapes, cherries, honey and corn syrup (not to be confused with high fructose corn syrup).

If you’ve ever wondered why a bowl full of raspberries has such a lower impact on your blood sugars than the same amount of carbohydrates from a bowl of grapes, it’s all about the amount of glucose, fructose and sucrose.

For example, here’s the breakdown of different types of fruit:

Using fructose to treat lows

Fructose is found naturally in most plant-based foods, which are healthy sources of carbohydrates, but unfortunately, these foods aren’t ideal for treating low blood sugar. Fructose is also found in many processed foods you can find at the grocery store, which don’t effectively treat your lows.

Common sources of fructose include: 

• Fruit
• Honey
• Agave
• Juice
• Pasta
• Veggies
• Bread and many more processed foods

The problem with using fructose to treat your lows all the time is that it does not break down into glucose to raise your blood sugar. Instead, fructose is first metabolized by the liver, which can raise triglyceride levels and promote fatty liver when consumed in large amounts. 

Diets high in fructose are also associated with higher levels of belly fat and even obesity. This is why “high fructose corn syrup” is a concerning ingredient in many processed foods, and why it’s important to distinguish it from fructose.

It’s not just a fructose problem

Most foods that contain fructose also contain varying amounts of glucose and sucrose, as shown in the graph above. If you use an apple or even a juice box to treat low blood sugar, only a portion of the carbohydrates in that apple will raise your blood sugar. 

Your body also has to break down the fibrous apple for the sucrose and glucose it contains to reach your bloodstream. This takes longer than using a glucose tab, where the digestion process is nearly instant.

Choosing carbohydrates that contain a lot of fructose to treat low blood sugars also means you’re consuming calories that aren’t helping you. Treating frequent low blood sugars with more calories than you need can make it harder to manage your personal weight goals and can lead to gradual weight gain.

Using sucrose to treat lows

Sucrose is a “disaccharide” or “double sugar” because it contains equal parts of glucose and fructose.

Common sources of sucrose include: 

• White/brown sugar
• Turbinado sugar
• Maple syrup
• Jelly beans
• Gummies
• Other processed candies/snacks

This means half of the carbohydrates in a packet of white sugar will raise your blood sugar quickly, and your liver will metabolize the other half.

While fast-acting carbohydrates containing sucrose are an effective option, glucose (dextrose) is still best. Using these types of sugars means you can treat low blood sugar more quickly and get faster symptom relief.

The bottom line: prepare with the best, manage with whatever you have

Low blood sugars are a real part of living with diabetes, especially if you take insulin. Being prepared for low blood sugar means keeping fast-acting carbohydrates in all the right places and training your loved ones to help you during a low blood sugar emergency before it happens. 

Many fast-acting carbohydrate options, such as glucose tablets, powders, or gels, are easy to store in your car, purse, nightstand, gym bag, desk, or coat because they don’t freeze, melt, or rot.

If you’re tired of waiting for the carbohydrates in a granola bar or a bag of gummies to raise your blood sugar, it might be time to take a closer look at the types of sugar in the foods you’re choosing to treat lows. They matter!

While glucose (dextrose)-based options are best, at the end of the day, this is about your survival, and you should use what’s available to you.
Feel like no one in your life understands what it’s like to go low and power through? We’re happy to tell you that you’re wrong. There’s a community waiting for you! Join the conversation in Beyond Type 1’s community apps.

Educational content related to diabetes management is made possible with support from ​Dex4, an active partner of Beyond Type 1 at the time of publication. ​Editorial control rests solely on Beyond Type 1.