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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Treating a low

No doses on this page

This handbook never gives insulin or medicine doses and never tells you to change one. Your prescriber sets every dose and every change, and writes down when to pause a medicine and when to restart it. A low blood glucose is always treated straight away: see Treating a low and Get help now.

In short

Treat a low straight away. Potassium never delays treatment. Take 15 g of fast carbohydrate, recheck in 15 minutes, and repeat if you are still low (ADA 2026 §6, recommendation 6.15). Glucose tablets are the best choice on a kidney diet: exact, fast, and free of potassium, phosphorus, sodium and fluid. If orange juice or cola is what is within reach, drink the measured 4 oz now and log it: one rescue portion is a budgeting note, an untreated low is an emergency. Everyone on insulin should have glucagon, and the people around them should know how to use it (ADA 2026 §6, recommendation 6.16).

Your numbers

Level Glucose What it means
Level 1 below 70 mg/dL treat now with 15 g
Level 2 below 54 mg/dL treat now with 15 g; tell your team
Level 3 any low where you need someone else's help a helper treats it; if you cannot swallow safely: glucagon, then call 911
Level Glucose What it means
Level 1 below 3.9 mmol/L treat now with 15 g
Level 2 below 3.0 mmol/L treat now with 15 g; tell your team
Level 3 any low where you need someone else's help a helper treats it; if you cannot swallow safely: glucagon, then call your emergency number

(ADA 2026 §6.) Kidney disease makes lows more likely, because failing kidneys clear less insulin and make less glucose (Pecoits-Filho 2016).

What to do: the rule of 15

  • Glucose below 70 mg/dL (3.9 mmol/L) and you can swallow: take 15 g of fast carbohydrate (ADA 2026 §6). On an automated insulin delivery system, ADA says 5–10 g is typical, but take the full 15 g if the low came with exercise or after a meal bolus that was too big for what you ate, and follow the amount your team has written down for you.
  • Do not use high-fat or high-protein foods (chocolate, milk, peanut butter) for the first treatment: fat slows the rise in glucose, and protein does not raise it (ADA 2026 §6).
  • Recheck in 15 minutes. Still low? Take another 15 g.
  • If your next meal is more than an hour away, have a snack once you are back in range (NIDDK).
  • Log the treatment in the app like any food. The app never warns against or blocks a low treatment.
  • If the person cannot swallow, is very drowsy or is fitting: give glucagon, put them on their side, and call 911 (or your local emergency number). Never put food or drink in the mouth of someone who cannot swallow safely.

Which 15 g to choose on a kidney diet

The ranking is about which 15 g to reach for when there is a choice. One 4-oz glass of orange juice is about 250 mg potassium, which a day's budget absorbs; an untreated level 2–3 low is a medical emergency. Never under-treat, and never use "sugar-free" sweets (sugar alcohols) to treat a low (ADA 2026 §6; NIDDK).

15 g option Carb g Potassium mg Phosphorus mg Verdict
Glucose tablets, 4 × 4 g (Dex4) 16 0 0 First choice: exact, fastest, no potassium, phosphorus or sodium (Dex4)
Glucose gel, 1 tube 15 about 0 0 Same; keep one at the bedside
Table sugar, 1 tbsp (3 tsp) 13 0 0 Clean and cheap; NIDDK lists 1 tbsp as a 15 g treatment, and 4 tsp gives about 17 g (NIDDK)
Hard candy, 3 pieces 18 1 0 Check the label; not "sugar-free"
Jelly beans, 15 small 15 about 6 0
Honey, 1 tbsp 17 11 1 Fine
Cranberry juice cocktail, ½ cup 17 18 1 Lowest-potassium juice; NIDDK's named alternative to orange juice (NIDDK)
Lemon-lime soda or ginger ale, regular, 4 oz 11–13 1 0 No phosphoric acid
Lemonade from concentrate, ¾ cup about 20 about 27 3
Applesauce, unsweetened, ½ cup 14 90 6 Good
Apple juice, ½ cup 14 125 9 Acceptable (NIDDK)
Grape juice, ½ cup 19 132 18 Acceptable (NIDDK)
Peaches or pears canned in juice, ½ cup 14–16 119–160 15–21 Acceptable, slower
Regular cola, 4 oz 13 6 about 11 (phosphoric acid) Use it if it is what is there; clear soda is the better habit
Orange juice, ½ cup 13 248 21 Use it if it is what is there, and log it (NIDDK; USDA)
Milk, 1 % fat, 1 cup 12 366 232 Poor: slow (protein and fat), high potassium and phosphorus
Banana, small 23 362 22 Poor
Milk chocolate bar 26 164 92 Poor: fat slows absorption (ADA 2026 §6)

Values per serving, USDA FoodData Central (FDC); see also DaVita.

Two habits: keep glucose tablets everywhere you go, and measure juice at 4 oz rather than "a glass". Over a day with two or three lows, tablets vs orange juice is several hundred milligrams of potassium.

On a fluid limit: glucose tablets and gel add no fluid; 4 oz of juice adds about 120 mL (Fluid).

On hemodialysis: glucose often falls during a session, and lows are most likely in the hours after it (JBDS–Renal Association; JBDS 2022). UK guidance says to check glucose before and after each session, to keep a low treatment within reach on the way to and from the unit, and to choose one that fits your fluid, potassium and phosphate limits (JBDS 2022, recommendations 5A.2–5A.4). See Insulin on dialysis.

Glucagon

  • Glucagon should be prescribed for everyone who uses insulin, preferably a form that does not need mixing, such as nasal or ready-to-use injectable glucagon (ADA 2026 §6, recommendation 6.16).
  • Family, friends, coworkers and the dialysis unit should know where it is and how to give it; ask your team or pharmacist to show them.
  • After glucagon, call 911 (or your local emergency number) and turn the person on their side.

Ask your care team

  1. Please prescribe glucagon (nasal or ready-to-use) and show my family how to use it.
  2. My lows are more frequent since my kidney function changed: should my insulin plan change?
  3. I use an automated insulin delivery system: how many grams should I take for a low, and when should I take the full 15 g?
  4. Can I keep glucose tablets at the dialysis unit, and what should staff do if I go low there?
  5. Should I be screened for not feeling my lows (impaired awareness)?

Get help now if…

  • The person cannot treat the low themselves, cannot swallow, is very drowsy, confused or fitting: give glucagon and call 911 (or your local emergency number).
  • Lows keep happening, happen at night, or you no longer feel them coming: call your team today. See Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.