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Treating Hypoglycemia: Guidelines for Dialysis Patients

Provided by DaVita® Dietitians

Hypoglycemia, or low blood sugar, occurs when blood glucose drops below 70 mg/dL. Causes include too little food, too much insulin or other diabetes medication, an increase in exercise or activity or a combination of any of these factors.

Decreased kidney function can also make a person more prone to hypoglycemia. It’s important to discuss a plan for treating low blood sugar levels with your doctor or dietitian. It’s recommended to treat blood glucose that’s less than 70 mg/dL.

Rule of 15 – Steps to treat low blood sugar

Follow these steps, known as the “Rule of 15” to treat low blood sugar.

  1. Eat a food or beverage containing 15 grams of carbohydrate (see below). Do not use orange juice. Also, avoid items with fat, such as chocolate bars, because fat can delay the rise of sugar in your blood.
  2. Retest your blood sugar after 15 minutes. If it is still less than 70 mg/dL, eat another portion of food or beverage containing 15 grams of carbohydrate.
  3. Recheck your blood sugar in 15 minutes. If it is still less than 70 mg/dL, eat another portion of food or beverage containing 15 grams of carbohydrate. If it is above 70 mg/dl, eat a small snack (i.e. 1/2 turkey sandwich) or eat a meal within the next hour.
  4. Since your blood sugar may begin to drop after 40 to 60 minutes, test again after one hour to make sure your blood sugar is in the range of 70-115 mg/dl.

Foods with 15 grams of carbohydrate

For dialysis patients, it is recommended to use any one of the following items, containing 15 grams of carbohydrate, to treat low blood sugar:

  • 3 glucose tablets, or 1 tube glucose gel (available in drugstores)
  • 1 tablespoon or 3 packets of table sugar
  • 1⁄2 cup apple juice or grape juice (avoid orange juice if you are on a low-potassium diet)
  • 7 gummy bear candies
  • 1⁄2 cup regular (not diet) Sprite®, ginger ale or 7-Up®
  • 6 Life-Savers®, or 2 to 4 pieces of hard candy

If hypoglycemia is an ongoing problem, keep one of these items with you at all times.

Symptoms of hypoglycemia

Symptoms of hypoglycemia can range from moderate to severe, including:

  • Blurry or double vision
  • Fast heartbeat
  • Nervousness
  • Irritability
  • Headache
  • Shaking or trembling
  • Sleeplessness
  • Sweating
  • Numbness
  • Weakness
  • Fainting
  • Seizure
  • Coma

Prevention of hypoglycemia

To help prevent blood sugar from dipping below 70mg/dL, follow your doctor’s advice about diet, medication and exercise. Remember to eat meals at regular times. Keep 15 grams of a carbohydrate-type snack handy at all times. Follow your dialysis diet and eat a healthy snack when exercising or being more active than usual.


Hypoglycemia can be a serious problem for people on dialysis. It is extremely important to have a plan of action for treating low blood sugar levels. Hypoglycemia can be treated and prevented by working with a doctor and renal dietitian.