Low Blood Sugar: Hypoglycemia 101

Marcia Kadanoff, who lives with type 2 diabetes, shares her top five tips for enjoying a Valentine’s Day meal out. Pink and red hearts everywhere, overpriced dinners, wondering if you’ll have a date (or if you got your partner an appropriate gift) – ah, the joys of Valentine’s Day. I’m stressed just thinking about it. As a person with diabetes, my stress may be a bit different than general Valentine’s Day anxiety. By this point, my spouse knows enough not to get me chocolates, my biggest landmine food. But the hard thing for Valentine's Day or any other romantic occasion is getting a reservation at the right kind of restaurant and – as always when living with diabetes – planning out my meal. Special occasion meals take special skills to navigate. The good news is that there are definitely strategies that can help make a romantic dinner somewhere special enjoyable without diabetes taking center stage. Where I live – the San Francisco Bay Area – many restaurants have Valentine’s Day dinner specials that consist of three to five courses. There’s nothing wrong with eating a multi-course meal, but it does make diabetes management more difficult. From bread to creamy soups and crouton-laden salads to heavy entrées to a dessert that’s potentially cake-filled, multi-course meals can quickly add up to a large amount of carbohydrates, which is a major driver of high blood sugars. The reality is that even if I choose the “healthier” set menu for a celebratory multi-course meal, I still make a point to think about what each portion is bringing (quite literally) to the table. Here are my best tips for navigating a Valentine's Day dinner out.

Figuring out when and how to exercise can be one of the most difficult parts of living with diabetes. Hear from experts who discuss the benefits and share strategies for safely exercising. Having diabetes doesn’t mean you have to let go of the things you love doing, which may include playing sports. Exercise is an essential part of diabetes management, leading to improved weight management, reduction in cardiovascular disease risk factors, and great mental health benefits. Experts like Dr. Lori Laffel, chief of the pediatric, adolescent and young adult section at Joslin Diabetes Center, discussed the benefits and strategies for safely exercising with diabetes. Laffel pointed to the ADA’s Standards of Care, which recommend adults get 150-300 minutes per week of moderate-to-vigorous exercise and youth get 420 minutes per week of moderate-to-vigorous exercise. But even with all of the evidence pointing to its benefits, managing exercise can be one of the most difficult parts of living with diabetes. There are multiple challenges to consider, such as abnormal insulin delivery and glucagon physiology, how stress hormones affect blood glucose, hydration, and more. The good news is that you can still stay active with diabetes and engage in the sports you love. Famous athletes who have diabetes include five-time Olympic gold medalist Gary Wayne Hall Jr., recent Super Bowl champion Noah Gray, and the Women’s National Basketball Association’s 2022 third overall pick Lauren Cox. Exercising just might mean a little more planning on your part. This includes paying special attention to the type of physical activity you’re doing, carb intake, and your insulin regimen, said Laffel. How does exercise impact blood sugar? It’s still difficult to know the degree to which exercise affects your blood glucose levels. According to Michael Riddell, professor of kinesiology and health sciences at York University, an optimal glycemic range is “unclear and very individualized for the athlete with diabetes.” Factors that influence one’s glucose response to exercise include the type of activity, time of day, whether you’ve recently taken insulin, what food was recently consumed, stress, sleep, and more. Athletes who compete may want to consider how their levels vary between training days versus competitions. While it might not always be doable in practice, Riddell recommends a time in range of 70% during training and 75% on competition days – while paying special attention to minimizing hypoglycemia to less than 1%. For competitive athletes, other important things to manage include sleep, meals, basal/bolus insulin, hydration, and workout schedules. The type, duration, and intensity of exercise are main factors that influence glucose response. Different forms of physical activity cause different glycemic trends that ultimately affect how you respond to diabetes management. For example, endurance activities (like walking, jogging, and cycling) tend to reduce glucose levels, whereas high-intensity interval training (HIIT) and resistance training tend to vary more so. Laffel said that if you are engaging in intense exercise, know it can cause hyperglycemia and may increase your insulin needs during recovery time. The amount of carbs you should eat to maintain your desired glucose levels will depend on the intensity of your exercise. Lower-intensity exercise typically means more carbs and less insulin needed and vice versa for higher-intensity exercise, explained Riddell. For context, about 50% of recreational athletes with type 1 diabetes prefer training and sometimes competing with a moderately low (100-200 grams per day), low (40-99 grams per day), or very low (<40 grams per day) carb diet. Helpful guidelines and tech for exercise Activity monitors and devices can significantly help with diabetes management while exercising. Connected pens and insulin pumps provide timely dosage; continuous glucose monitors (CGM) let you follow trends to guide your insulin dosing and carb intake; and automated insulin delivery (AID) can protect you from hypoglycemia and possible hyperglycemia. Laffel provided a few basic guidelines if you’re engaging in aerobic exercise for more than 40 minutes. If you’re on multiple daily injections (MDI) or an open-loop pump, consider the following insulin adjustments: For those on MDI, start with a 20% reduction in basal insulin dose. For people on insulin pump therapy, reduce basal rate by about 50% (as a starting point) 1-2 hours before, during, and about one hour after exercise. Reduce bolus insulin by 50% for meals or snacks two hours before and up to two hours after exercise. At bedtime (or 7-11 hours following afternoon exercise) reduce your basal rate by 20% for up to six hours. If you are engaging in unplanned aerobic exercise, eat a few extra carbs. Use a CGM or monitor to check glucose before, during, and after physical activity. According to Laffel, an overlooked but important part of exercising with diabetes is the cool-down period, which can be any sort of exercise that you consider easy, such as walking or a slow jog. Cooling down can reduce your risk of hyperglycemia after vigorous exercise. You should cool down for about 20 minutes. If your glucose levels remain high, you can consider conservative insulin correction (greater than 220 mg/dL). Ultimately, there are many ways you can tailor diabetes management to work for your exercise plan. You should discuss your exercise regime with your doctor, as everyone’s needs are individualized and dependent on their lifestyle.

Game day is fast approaching. Here are six diabetes-friendly healthy snack recipes that are all sure to be instant crowd-pleasers. Are you ready for the big game? Whether you're a raving football enthusiast, solely a fan of the commercials, or just around for the food and comradery, it's impossible to deny that the Super Bowl is a big deal. It's important to make sure you'll stay healthy while helping yourself to a few delicious bites. “Traditional Super Bowl snack foods are less than ideal, even if you aren't living with diabetes,” says Heather Hanks, a certified nutritionist and medical adviser at Medical Solutions BCN. Hanks acknowledges that it's always a challenge to eat healthy on Super Bowl Sunday. “The key here is to find snacks that contain no refined sugars and fewer carbs, a good source of protein, healthy fats, and fiber to keep you full and stabilize blood sugar levels.” Diabetes-friendly snacks for game day Bearing these pointers in mind, we have six low-carb finger food options, from cheese dips to buffalo-style cauliflower bites. These healthy snack options will have you partaking in the party without feeling too full or weighed down. 

Story at-a-glance Consuming dark chocolate is linked to a 21% reduction in the risk of developing Type 2 diabetes, while milk chocolate does not offer the same benefit and is associated with weight gain

A while back, I shared some of the advantages of chia pudding, and I’ve since been shocked by the positive response. “Adam, thank you so much,” one diaTribe reader wrote me to say. “I’ve been looking for a breakfast like this for 25 years! It has changed my life.” Parents have even emailed me with enthusiasm for this recipe –“My son loves this!” – meaning this isn’t just a weird concoction for health nuts like me. For those of you who aren’t familiar with the kitchen wonder that is chia pudding, it’s truly the simplest breakfast to make, and it offers so many benefits – little impact on blood glucose, three minutes to make without cooking, inexpensive, stocked with fiber and omega-3s, and filling and tasty – that you might just feel the same way. I’ve walked through how to make it in a video, and for those of you who’d prefer reading the recipe, the written details on how to make chia pudding are also below. What are chia seeds? Chia seeds are the edible seeds of a flowering desert plant, Salvia hispanica, a relative of the mint family. They look a lot like poppy seeds and are packed with fiber, protein, and healthy Omega-3 fats. On their own, chia seeds don’t taste like anything, so it’s all about how they are flavored—hence the recipe. Where to buy chia seeds I buy chia seeds in bulk online; a two-pound bag from Viva Labs on Amazon costs about $10 and covers about 20 breakfasts. They can also be purchased at regular grocery stores, natural foods stores, and even corner stores, usually in one-pound bags. They are often in the baking section or near where bags of rice and beans are sold. They may also be in the bulk foods aisle, near any nuts, or a in health foods and vitamin section as well. How to make chia seed pudding To make chia seed pudding, mix 1/4 cup of chia seeds with 1/2 cup of water . If you’re me, you’ll also add a hearty amount of cinnamon , 1-2 tablespoons of coconut oil , and some combination of toppings such as fruit, seeds, and nuts . (For instance, I like frozen raspberries, shelled sunflower seeds, and almonds.) After about a minute of stirring with a spoon and about a minute sitting , it turns into a pudding-like gel. Chia pudding can also be made ahead of time, and you can double or quadruple the recipe. The water can be hot or cold, depending on your preferences, and the pudding can be made thicker by using less water. Chocolate or vanilla protein powder or pure vanilla extract can be added for additional flavor. There is nothing exact about this recipe, so experiment with the components and toppings to fit your tastes. For example, you can try this Overnight Berry Chia Pudding. I also know someone that makes it with lemon juice, stevia, and almonds. There are many other chia seed pudding recipes on the Internet, though most contain some amount of added sugar, such as honey, maple syrup, date syrup, or coconut sugar. Enjoying chia seed pudding with diabetes When it comes to bolusing for insulin when eating chia pudding, I generally take one unit of insulin for chia seed pudding as I start eating, which covers the very slow blood glucose rise from fat, protein, and the small amount of carbs from the toppings. Each 1/4 cup of chia seeds has 20 grams of carbs, though 16 grams are from fiber (80%), translating to little blood sugar impact. A note about chia seed pudding for people with sensitive stomachs If you have any gastrointestinal discomfort with this recipe, try making the chia pudding in a batch and letting it sit overnight. Some readers have written in to add that soaking chia seeds in water for a longer period of time has made chia seed pudding easier for them to digest. 

Key takeaways: U.S. News & World Report has released its 2025 list of best diets, including top-ranked diets for people with diabetes. The list includes nutritious eating patterns such as the Mediterranean diet, the DASH Diet, and the MIND Diet. These dietary eating patterns are optimal for people who are trying to keep blood sugar levels stable. For people living with diabetes, it’s important to eat in ways that help keep blood glucose levels within normal range consistently throughout the day, rather than rapidly fluctuating between figures that are high and low. This often translates to a focus on eating regular, portion-mindful meals that feature lean sources of protein and whole foods plentiful in fiber, along with limiting food or drinks that are high in sugar or simple carbohydrates. U.S. News & World Report issues a list of top diets at the start of each year, with a ranking of their favorites in various health categories, including diabetes and prediabetes. Below are the top four results for the diabetes category, listed in ranked order – plus a bonus honorable mention from the editorial team at diaTribe. While all of these diets – better described as meal patterns – favor whole foods as well as minimize added sugars and refined carbohydrates, their approaches vary. All of these diets, however, have been shown to help improve blood sugar levels while providing adequate nutrition. 1. The Mediterranean diet The Mediterranean eating pattern focuses on consuming an abundance of vegetables, fruits, legumes, beans, nuts, and seeds with low to no red meat intake. It also encourages whole grains, extra virgin olive oil as a main source of healthy fat, moderate amounts of fish rich in omega-3 fatty acids (such as salmon or tuna), and cheese and yogurt . Sweets should be consumed sparingly, if at all. Benefits of the Mediterranean diet Studies have shown that the Mediterranean diet can improve insulin sensitivity, help regulate blood sugar, reduce A1C levels , and lower the risk of type 2 diabetes. Notable health organizations, including the American Heart Association (AHA) and the American Diabetes Association (ADA), have endorsed the Mediterranean diet. What’s more, the Mediterranean diet adds flexibility. “The Mediterranean meal pattern is based on a general pattern of eating that can be adapted to different cultural traditions and food preferences,” said Daisy Seremba, a Georgia-based registered dietitian and certified diabetes care and education specialist. “There are no exclusions of specific foods or food groups, making it easy to follow long term and maintain the health benefits it offers.” Drawbacks of the Mediterranean diet The Mediterranean diet offers many benefits and is an excellent option for most people, but cost may be a concern. “Some consumers report the cost of such things as olive oil, fish, nuts, and seeds may be prohibitive for their budgets,” Seremba said. She recommends shopping for frozen fish or canned varieties, which confer many of the same benefits, as a way to save on the cost of purchasing items such as fresh seafood. Those on the Mediterranean diet may also need to be mindful of carbohydrate content. “Because the Mediterranean diet promotes the intake of fruits, vegetables, and whole grains, people with diabetes may need additional guidance from a registered dietitian or diabetes care and education specialist to ensure they are following their meal plan and limiting their carb intake as needed,” Seremba said. 2. The flexitarian diet The flexitarian eating pattern is a mix between vegan and vegetarian with the flexibility to consume animal products in limited amounts. The majority of foods eaten are plants, nuts, seeds, whole grains, legumes, fruits, and vegetables. It includes three stages: The first stage limits meat to two days per week with no more than 28 ounces per week. The second stage consists of consuming more plant-based foods (eggs and dairy are allowed) three to four times per week, with less than 18 ounces of meat weekly. The third stage limits meat to no more than 9 ounces per week. If you follow the flexitarian diet, you’ll primarily eat plant-based foods, with occasional lean, organic, grass-fed or pasture-raised meat, poultry, eggs, dairy, and fish. Benefits of the flexitarian diet “The flexitarian eating pattern encourages consumption of more plants as the base of the diet with less emphasis on consuming meat, which is more environmentally friendly and healthier in terms of saturated fat content. In addition, a flexitarian diet is higher in fiber, fruits, and vegetables than the typical or standard American diet,” said Sue-Ellen Anderson-Haynes, a registered dietitian and national spokesperson for the Academy of Nutrition and Dietetics. Anderson-Haynes said the flexitarian diet may be a good option for people with diabetes. She pointed to a 2019 study showing that people who closely followed plant-based dietary patterns had a 13% lower risk of developing type 2 diabetes, compared to those who did not strictly follow a plant-based diet. “Plant-based diets, such as the flexitarian diet, are plentiful in fiber, antioxidants, magnesium, and other nutrients that are well documented in research to assist with the prevention and management of chronic illness such as heart disease, cancer, and diabetes,” said Anderson-Haynes. “In terms of managing diabetes, plant-based diets have shown promising results to slow down complications related to diabetes,” Anderson-Haynes said. “Conversely, research reports that diets high in animal protein increase diabetes risk.” Drawbacks of the flexitarian diet The flexitarian diet imposes no limits on the amount of eggs or dairy consumed. "There is no true limit on eggs and dairy as there is with meat, so people following this diet may not know how much of these foods to limit or to consume,” Anderson-Haynes said. 3. The MIND diet The MIND eating pattern, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, is a combination of the Mediterranean and DASH eating patterns. The MIND diet encourages people to consume vegetables, nuts, olive oil, whole grains, berries, fish, beans, poultry, and wine in moderate amounts, although newer studies recommend against having any amount of alcohol). Benefits of the MIND diet Both the Mediterranean and DASH eating patterns have been shown to positively impact the management of diabetes and its comorbidities, including high blood pressure, cardiovascular disease (CVD), high blood cholesterol, and obesity. Several studies also suggest that MIND can slow the progression of Alzheimer's disease, although the specific nutritional components responsible for these possible benefits or their mechanism of action haven’t been well studied. “Several studies suggest that healthy fats, like omegas in olive oil and phytochemicals in berries, might be responsible for the neuroprotective effects,” said Sandra J. Arévalo Valencia, a CDCES and director of community health and wellness at Montefiore Nyack Hospital in New York. “In addition to reducing the risk of mental illness, it can help control weight, improve glycemia, improve cholesterol levels, and reduce hypertension,” Valencia said. “MIND doesn’t restrict any food groups, allowing for well-balanced meal plans that can be followed long term without causing any dietary insufficiencies.” Drawbacks of the MIND diet “When talking about MIND with my patients with diabetes, I recommend they exercise caution with the amount of fruit and nuts they consume. Excessive fruit intake could increase glycemia (blood glucose levels),” Valencia said. “In addition, the high fat content of nuts could cause weight gain. The fact that you are eating good fats doesn't take away from the reality that all fats are high in calories.” As with the Mediterranean eating pattern, Aravelo said MIND can be expensive, as ingredients such as fresh berries, olive oil, avocados, salmon, and other recommended foods tend to be costly. 4. The DASH diet DASH – which stands for Dietary Approaches to Stop Hypertension – emphasizes healthy foods like fruits , vegetables, whole grains, lean proteins, and low-fat dairy, while discouraging red meat, added salt, sugar, or saturated fat. This eating pattern is a flexible, heart-healthy diet that can help manage high blood pressure and prevent cardiovascular disease. Eating the DASH way results in a nutrient-dense meal plan high in potassium, calcium, magnesium, fiber, and protein; the ADA has published a consensus report on the effectiveness of the DASH meal plan for people with diabetes. Benefits of the DASH diet In addition to promoting blood pressure control, this eating pattern has been shown to improve insulin resistance, high cholesterol, and obesity, said Kari Garner, a South Carolina-based registered dietitian and CDCES. Garner pointed to a 2022 study that linked the DASH diet to lower mortality risk among individuals with diabetes. “The DASH diet encourages the intake of nutrient- and fiber-rich foods, which can promote weight loss and decrease blood pressure and cholesterol. The DASH diet also has cardiovascular benefits similar to the Mediterranean diet,” Garner said. Drawbacks of the DASH diet One challenge of DASH is that more than 50% of the calories come from carbohydrates, which may be too high for some people with diabetes. DASH carbohydrates may range between 180-270 grams per day, depending on the calorie level. There’s also the challenge of keeping sodium to below 2,300 milligrams (less than 1 teaspoon) per day. “DASH may be hard to sustain due to perceived lack of flavor in foods,” Garner said, adding that limited culinary skills, affordability of fresh ingredients, and lack of an organized support system as other possible impediments to success on DASH. 5. diaTribe honorable mention: The vegan diet This diet, which came in at number seven, didn’t make it to the top of the U.S. News rankings in 2025. Nevertheless, diaTribe believes it deserves special mention for its noted preventative benefits to the heart and liver, parts of the body that are especially important to care for to avoid complications with diabetes, as well as to the gut microbiome. Following a vegan eating pattern means eliminating all animal products from your diet – no meat, fish, or dairy. Some vegans also exclude honey and gelatin from their diet. This eating pattern focuses on primarily eating grains, fruits, vegetables, legumes, nuts, and seeds. While the vegan diet is certainly more limited than a vegetarian diet, there are many new plant-based protein sources offered at grocery stores, restaurants, and even major chains across the U.S. Benefits of the vegan diet Unlike other diets, the vegan diet has fairly straightforward requirements: all plant foods are included. As long as it comes from a plant, you can eat it. There are no strict limits on the number of calories or the amount of food you eat. Vegan diets are generally high in fiber and low in saturated fats, so they fit within a heart-healthy diet and align well with dietary guidelines for people with diabetes. A small study of people with type 1 diabetes found that the vegan diet delivered several benefits, including reduced total daily insulin dose, improved insulin sensitivity, and weight loss. Research suggests following a plant-based diet can reduce the risk of several chronic conditions, including CVD, obesity, and even some cancers. Drawbacks of the vegan diet When you eliminate all animal products from your diet, it can be difficult to get enough of certain nutrients, like vitamin B-12 and iron. Experts recommend taking a certified B12 supplement and consulting with your healthcare provider if you experience any symptoms of B12 deficiency, such as: Cognitive changes like depression, fatigue, and memory impairment Muscle weakness Breathlessness Weight loss Increased heart rate While it’s certainly possible to get enough protein from plant sources, you may have to think creatively at first and explore other options like tofu, tempeh, lentils, plant-based milks, nuts, and seeds. The bottom line: What’s the best diabetes diet for blood sugar management? No eating plan or pattern for diabetes is magical. However, with careful consideration and an understanding of your personal goals, preferences, and capacity to adjust, one of these meal patterns may be right for you. Combining one of these eating patterns with the diabetes plate method – a recommendation of half non-starchy vegetables, one-quarter protein, and one-quarter carbohydrate foods – can help you create balanced, healthy meals and manage blood sugar. Of course, it’s important to combine healthy meals with physical activity to support blood glucose control, maintain a healthy weight, and reduce the risk of diabetes complications. If you’re looking for assistance with meal planning, a registered dietitian and CDCES can help. Here is a helpful database to find a CDCES who can work with you.

Ever been in a situation where someone just didn’t get it when it comes to diabetes? You’re not alone! In the final video of the Spoonful of Laughter series, comedian Kesha Carter, filmmaker Kelsey Bascom, and diabetes creator Justin Eastzer take a hilarious dive into what happens when misunderstandings meet real-life diabetes experiences.

If you’re still trying to get in the holiday spirit, there’s nothing better than a seasonally appropriate cocktail to sip on this time of year. I’ve created three cocktails that feature nostalgic childhood flavors and garnishes meant to wow but also utilize lower-carb ingredients. Enjoy these all season long – with little insulin required! 

Could the spices in your kitchen cabinet protect or even improve brain health? Research suggests spices contain properties beneficial to health, plus they add wonderful flavor and depth to any dish.