What blood sugar level is too low?

For most people with diabetes, a hypo is a blood sugar below 4 mmol/L, which is about 70 mg/dL, the unit many meters in Jordan show. The CDC describes below 54 mg/dL (3.0 mmol/L) as severe. Your own target may differ, so agree with your doctor what level you should treat. If you have symptoms and can't check, treat it as a hypo anyway.

What is the 15/15 rule for low blood sugar?

Take 15 to 20 grams of fast-acting sugar, such as half a cup of regular juice, half a can of regular (not diet) soda, 4 glucose tablets or a tablespoon of sugar dissolved in water. Recheck after 15 minutes. If it's still below 70 mg/dL, repeat. Once it's back up, eat a starchy snack or your next meal to stop it dropping again.

What should I do if someone with diabetes is unconscious?

Don't put food, drink or sugar in their mouth, because they could choke. Place them in the recovery position on their side and call 911. If they have glucagon and you've been shown how to use it, give it straight away. Stay with them. If they wake and can swallow safely, give them something sugary and then a snack.

Can I fast in Ramadan if I have diabetes?

Many people with diabetes can fast safely, but it depends on your type of diabetes, your medicines and your health. Talk to your doctor a few weeks before Ramadan, as doses or timings often need changing. IDF-DAR guidance says to break the fast straight away if your blood sugar drops below 70 mg/dL (3.9 mmol/L) or you have hypo symptoms. Checking your sugar doesn't break the fast.

Do Ozempic or metformin cause low blood sugar?

Metformin or GLP-1 medicines such as semaglutide (Ozempic) used on their own rarely cause hypos. The risk is much higher with insulin and with sulfonylureas such as gliclazide or glimepiride, and rises when a GLP-1 medicine is combined with one of those. If you start a new diabetes medicine and get shaky or sweaty spells, check your sugar and tell your doctor.

Can you have low blood sugar without diabetes?

It's rare. The NHS lists causes such as malnutrition, some hormone problems and, very rarely, a tumour in the pancreas. Shakiness after skipping a meal is common and usually not true hypoglycaemia. If you've had symptoms of a hypo and you don't have diabetes, see a doctor, and come in urgently if you were confused, fainted or needed help from someone else.

Low Blood Sugar (Hypo): Symptoms, What to Do, When to Call 911

Diabetes is common in Jordan, and almost every family has someone on insulin or diabetes tablets. So it helps if everyone, not just the person with diabetes, knows what a hypo looks like and what to do. Most hypos are treated quickly at home, but one can become dangerous if treatment is delayed. This guide covers the symptoms, the 15/15 rule, what to do if someone passes out, fasting in Ramadan, and when to come to the ER.

What are the symptoms of low blood sugar?

Symptoms vary from person to person, so learn your own signs. The most common, according to the NHS and CDC, are shaking, sweating, hunger, irritability or anxiety, dizziness, tingling lips, a fast heartbeat and tiredness. As it goes on, blurred vision, confusion, trouble walking or speaking, and strange behaviour can follow, which people sometimes mistake for drunkenness or a bad mood. A severe hypo can cause a seizure or loss of consciousness.

When is blood sugar too low? The NHS uses 4 mmol/L and the American Diabetes Association uses 70 mg/dL, which are roughly the same. Many meters in Jordan show mg/dL, so check the unit on yours. If you have symptoms and can't check, treat it as a hypo.

What should you do for a hypo?

If the person is alert and can swallow, follow the 15/15 rule recommended by the American Diabetes Association and the US NIDDK, which matches the NHS steps:

Take 15–20 g of fast-acting sugar.
Wait 15 minutes, then recheck your blood sugar.
If it's still below 70 mg/dL (4 mmol/L), repeat step 1.
Once it's back up and you feel better, eat something starchy such as bread, biscuits or your next meal if it's due.

Examples of 15 g of fast-acting sugar you'll find in any home or corner shop: half a cup (about 120 ml) of regular fruit juice, half a can of regular soda (not diet or zero), 4 glucose tablets from the pharmacy, a tablespoon (3–4 teaspoons) of sugar dissolved in water, or a tablespoon of honey. Chocolate and pastries work more slowly because the fat delays the sugar, so don't start with them.

What if the person is unconscious?

Never give food, drink or sugar to someone who is unconscious or can't swallow, as they could choke. Put them on their side in the recovery position, call 911 and stay with them. If their doctor has prescribed glucagon (an injection or nasal spray) and the family has been trained to use it, give it straight away. According to the NHS, if they come round within 10 minutes and can swallow safely, give them something sugary and then a snack. If someone at home takes insulin, ask their doctor about glucagon and teach the family how to use it.

How severe is it, and what should you do?

Severity	What it looks like	What to do
Mild	Shaky, sweaty, hungry, irritable, tingling lips, fast heartbeat; still alert and able to swallow	15/15 rule: 15–20 g fast-acting sugar, recheck after 15 minutes, repeat if still low, then a starchy snack
Moderate	Confused, drowsy, blurred vision, slurred speech, acting strangely or clumsy; may need help to treat it	Someone helps them take sugar if they can swallow safely; stay with them; come in if confusion doesn't clear
Severe	Unconscious, unable to swallow, or having a seizure	Nothing by mouth. Recovery position, glucagon if prescribed and you're trained, and call 911

Who is at risk of a hypo?

People on insulin or sulfonylureas such as gliclazide and glimepiride. These medicines can keep working for many hours, so a hypo may come back after you've treated it.
GLP-1 medicines such as Ozempic, and metformin, rarely cause hypos on their own, but the risk rises when they're combined with insulin or a sulfonylurea. See also our guide to Ozempic warning signs.
Missed or delayed meals, and hard exercise without extra food or an adjusted insulin dose.
Alcohol, especially without food, which both raises the risk and hides the early symptoms.
Night-time hypos: these can happen during sleep without you noticing. Signs include nightmares, sweating enough to soak your clothes or sheets, or waking tired, confused or irritable. If it keeps happening, tell your doctor.

Can you fast in Ramadan with diabetes?

Many people with diabetes fast safely, but fasting changes when you eat and take your medicines, which raises the risk of a hypo, especially in the hours before iftar. According to International Diabetes Federation and DAR International Alliance (IDF-DAR) guidance: see your doctor a few weeks before Ramadan to check whether fasting is safe for you and adjust your doses and timings, check your sugar regularly while fasting (checking doesn't break the fast), and break the fast straight away if your sugar drops below 70 mg/dL (3.9 mmol/L) or you have hypo symptoms. Your health comes first, and breaking the fast in this situation is permitted.

When should you go to the ER for low blood sugar?

Call 911 for

Unconscious or unable to swallow, and there's no glucagon or no one knows how to use it.
Glucagon was given but they haven't come round within 10 minutes.
A seizure.
A severe hypo after drinking alcohol.

Go to the ER now

A hypo that doesn't respond after 2–3 rounds of treatment.
Confusion or drowsiness that persists even after the sugar comes up.
After a severe hypo where the person needed someone else's help or glucagon, even if they've recovered.
A hypo in someone taking a long-acting sulfonylurea, as it may come back within hours.
A first confirmed hypo in someone without diabetes, with confusion or fainting.

Urgent care or a doctor the same day

Repeated hypos over the last few days, or a night-time hypo.
Hypo-like symptoms in someone without diabetes who has since recovered.
A hypo after starting a new medicine or changing a dose, or during an illness when you're eating less.

Home care is usually fine

A mild hypo in someone alert that improved with the 15/15 rule and a snack, with a clear cause (such as a late meal).
Mention it to your doctor at your next appointment and keep a record of your readings.

If dizziness or fainting is the problem and you're not sure why, our guide to fainting, dizziness and when to go to the ER can help. And save the emergency numbers in Jordan on your phone and on the phones of the people you live with.

What happens when you come in?

Tell the team straight away that the person has diabetes and which medicines they take, and bring the meter or medicine boxes if you can. The doctor may check the blood sugar right away, treat the hypo and watch the person until they're stable, especially if they take a sulfonylurea. If the cause isn't clear, the doctor may request other tests from the on-site laboratory, then arrange the next step. The emergency department is open 24/7, and urgent care sees walk-ins for milder problems.

Hypo that won't come up?

If someone is unconscious or can't swallow, call 911 now and put nothing in their mouth. If sugar doesn't come up after 2–3 rounds of treatment or confusion persists, don't drive yourself; get someone to bring you to the emergency department at Emergency Plus in Dabouq, Amman, open 24/7. Arabic and English speaking team.

Call us 24/7: +962 79 247 1313

Sources

Medical disclaimer: This article is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. If you think you are experiencing a medical emergency, call 911 or go to the nearest emergency department immediately. Emergency Plus in Dabouq, Amman is open 24/7 — +962 79 247 1313.