What Is the 15-15 Rule
The 15-15 rule, also known as the rule of 15’s, is a key method for diabetics to manage and correct a low blood sugar, which is also called hypoglycemia.
Hypoglycemia is defined, for most people with diabetes, as a blood sugar less than 70 milligrams per deciliter (mg/dL). For many people having a glucose level <70 means they start to feel the symptoms of hypoglycemia, which include: shakiness or trembling, sweating, rapid heart rate, mood changes/irritability, anxiety, hunger, dizziness, or light headedness.
It is very important for people living with diabetes to have a good understanding of this rule, especially for those on insulin. The reason is, a severe low blood sugar that goes untreated, can lead to a coma or even death.
It is important for all people to understand the signs of hypoglycemia and prevent it from happening if possible. But for those on insulin injections or an insulin pump, it can be life saving to recognize and treat it early.
Understanding the 15-15 Rule
The 15-15 rule is simply this - if your blood sugar is less than 70, consume 15 grams of fast acting carbohydrates, wait 15 minutes, and check to ensure your glucose has corrected above 70. If it is still below 70, repeat the step of consuming 15 grams of carbs.
If it is above 70 and you are going to be consuming a meal within the next hour, you should be ok until then. But if you won’t be eating for more than an hour, it is recommended to have a well balanced snack in the meantime to stabilize your glucose levels.
If the step must be repeated and this is done several times and glucose levels don’t start to rise or stabilize, it is important to seek emergency medical attention right away.
Why 15 Grams of Carbohydrates?
There are a few scientific reasons behind the 15 grams of fast acting carbs being used to correct, but essentially, it provides controlled glucose elevation.
It does this by raising the blood glucose quickly with the amount of glucose needed, with minimal risk of over correcting and the timing of the recheck being correlated with the timing it takes to start impacting glucose levels after ingestion.
How to Use the 15-15 Rule Effectively
For most people who are diabetic or may struggle with hypoglycemia, they can detect low glucose symptoms fairly quickly.
There are instances of hypoglycemia unawareness, where the person with diabetes no longer feels the impacts of the glucose levels dropping and is essentially unaware when it takes place.
It is important to be aware of the symptoms of low blood sugar and ensure your glucometer or CGM is reliable and working correctly.
There are alarms on CGM’s where you can adjust the setting to alert you when you are starting to go low, in order to catch it and correct it early.
Using the correct amount and type of carbs is also essential in using this rule effectively. Many people consume way too many (understandably because of how they feel) then experience a rebound high. This can become a very frustrating roller coaster ride.
If complex carbs are consumed in an attempt to correct a low and or fast acting carbs are coupled with fats or proteins, this will slow down the digestion and absorption and not effectively and promptly correct the low.
Examples of Fast-Acting Carbs for the 15-15 Rule
Some of the most used fast-acting carb options consumed (in 15 grams) for the 15-15 rule
include: glucose tablets (3-4), glucose gel, 4 oz of juice, 1 tablespoon of honey or table sugar, or 2 tablespoons of raisins.
It is of utmost importance for people to always be prepared and have these fast acting carbs available on them to correct a low. Often, people will go out shopping or running errands and forget to pack a snack and end up having a low.
It is good practice to place these items in your bag, backup diabetes emergency supply kit, your car, and even at your bedside.
The 15-15 Rule and Closed-Loop Insulin Pumps
For those on hybrid closed loop insulin pumps, there are some special considerations. These pumps are created to reduce or suspend insulin when glucose is dropping, therefore there is likely less active insulin on board.
With there being less insulin actively lowering blood sugar, it will likely require less carbs to correct the hypoglycemia.
Although these insulin pumps can adjust the insulin delivery, they do not administer glucose and therefore a correction is still necessary if you are low.
It is helpful to monitor CGM trends and review pump data periodically to ensure optimal pump settings to decrease the incidences of low glucose. Also, finding the right amount of carbs that corrects, but also avoids over correction, is important to not start a roller coaster with the glucose levels.
Handling Severe Hypoglycemia Beyond the 15-15 Rule
Severe hypoglycemia is what occurs when blood sugar levels drop below 54 mg/dl and the response can include a range of neurological, behavioral, and physical symptoms.
The neurological symptoms can be: confusion or inability to concentrate, slurred speech, blurred vision, dizziness or lightheadedness, loss of coordination or consciousness, and seizures.
The behavioral symptoms can include: irritability or mood swings, unusual aggression, or difficulty communicating. Physical symptoms: profuse sweating, rapid or irregular heartbeat, shakiness or tremors, and severe fatigue or weakness.
If severe hypoglycemia is left untreated, it can lead to coma or death. When a person is experiencing severe hypoglycemia, the 15-15 rule is not enough and it must be treated with glucagon. This is a rescue medication for severe hypoglycemia and can be administered as an injectable or nasal spray.
Some common examples of glucagon are Gvoke and Baqsimi.
If a person is unconscious and remains unconscious, has difficulty breathing, is not responding to the glucagon, or sustains a severe injury as a result of hypoglycemia, call 911 or seek immediate medical help.
Preventing Hypoglycemia and Mastering the 15-15 Rule
It is very important to prevent hypoglycemia and or catch and treat it before it becomes severe. Some causes of hypoglycemia include: missed meals, over estimation of insulin dose, and exercise.
To prevent hypoglycemia, it is important to not skip meals or take insulin before you know when or what you are going to eat.
It is also important to learn how to calculate carbs and insulin doses correctly as well as setting CGM alerts (and confirming you can hear the alerts) for falling glucose values, as well as keeping snacks and a form of correction on hand; especially during activities.
The 15-15 rule is very simple and effective for managing low blood sugar and minimizing the risk of rebound highs. It should be well understood and included in all diabetes management plans, especially for insulin users.
To learn more about better managing your glucose and minimizing your risk of severe lows and highs, reach out to speak directly with me.
Hi! I’m Beth, a Registered Nurse and Certified Diabetes Educator. I provide diabetes coaching for newly diagnosed people with diabetes and also work with people who have been living with diabetes for some time.
With 1:1 coaching, you will feel empowered and supported to confidently manage your diabetes effectively - without it controlling your life! I can help you make sure that you feel good, stay in optimal health and take care of your well-being at all times.
First call is on me! Let’s talk.
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