If you take a GLP-1 medication like Ozempic, Mounjaro, Zepbound, or Wegovy, you already know that these medications can be absolute game-changers for insulin sensitivity and glucose stability.
However, as with any change to our metabolic routine, there is a learning curve. For many people in our T1D community, one of the most surprising and sometimes stressful shifts is how these medications change how we react to low blood sugars.
We’ve all had that moment of panic where our blood sugar is dropping at an alarming rate, you start eating everything in sight, and your blood sugar just won’t come up fast enough.
When you are on a GLP-1, lows can happen more frequently, and more importantly, they can feel and act differently than what you’ve experienced in the past. Understanding the why behind these changes is key to staying safe and avoiding those unfortunate rebound highs that happen when we overtreat a low.
Please note, this post is not medical advice. Make sure to consult with your healthcare team before making any changes to your diabetes management routine. Some of the links below contain affiliate links. This means that if you click on a link and purchase a product, I may get a small commission at no cost to you.
Why Low Blood Sugar on a GLP-1 Might Be Happening More Frequently
GLP-1 medications work through several pathways, some of which can increase your risk of lows if your insulin doses aren’t adjusted accordingly. This is especially important to be aware of when you start taking a GLP-1 or when you increase your dose.
- Increased insulin sensitivity: GLP-1s reduce insulin resistance. This means the insulin you are injecting (or that your pump is delivering) works better than it did in the past. What used to be a standard dose might suddenly be too much for your more sensitive cells.
- Reduced food intake: These medications are known to quiet “food noise” and reduce hunger. When you eat less, your previous basal and bolus settings may overestimate your body’s actual needs and may need to be tweaked.
- Slower gastric emptying: GLP-1 medications slow down the rate at which food leaves your stomach. If there is a mismatch between when your insulin peaks and when your food is actually absorbed, you can end up with a low.
- Weight loss: When you lose weight, your insulin needs will likely decrease. If you have lost weight since starting a GLP-1 medication and you are still taking the same amount of insulin, you may start to see more frequent lows.
Why Low Blood Sugar Feels Different on a GLP-1
The most significant challenge of managing a low while on a GLP-1 is the slower gastric emptying. Traditionally, we are taught the “Rule of 15”, which means eat 15 grams of carbs and wait 15 minutes for the blood sugar to come up.
On a GLP-1, that 15-minute wait can feel like an eternity because the carbs you just ate are sitting in your stomach longer before reaching the small intestine, where they are absorbed into the bloodstream. This lag can mean it takes significantly longer for your blood sugar to start trending upward. This often leads to over-treating, where we eat everything in the pantry because we don’t feel the rise happening quickly enough, only to end up with a massive spike a few hours later.
The Best Way to Treat Low Blood Sugar on a GLP-1: A Situational Approach
Because of the slower absorption rate, “one size fits all” doesn’t work for treating lows on a GLP-1. You have to look at your CGM trends and the context of your day.
- The slow drift (catching it early): If you see a gentle downward drift but aren’t yet in the danger zone, try eating a small amount of carbs plus protein. The carbs will give your blood sugar a little boost, while the protein provides a more sustained floor to prevent further drops without causing a spike.
- Trending low and dropping (not yet urgently low): If you are steadily dropping, you need simple, fast-acting carbohydrates. This is the time for a carb-containing snack with little to no protein or fat, but it doesn’t necessarily need to be pure dextrose. A small piece of fruit or a granola bar would work well.
- The rapid drop or urgent low: When you are already low, or the arrows are pointing straight down, you cannot wait for your stomach to process food. You need pure glucose (dextrose) that begins absorbing immediately.
- During aerobic exercise: Exercise increases insulin sensitivity even further. If you are active, always opt for pure glucose to get your numbers up as quickly as possible, especially when you have active insulin on board.
Important Variables to Consider
Blood sugar control is never just about the carbs, there are quite a few other variables to consider. Rapid-acting insulin stays active in your body for around 3-5 hours for most people. If you have a significant amount of active insulin in your system or plan to be physically active, you will likely need more aggressive treatment to prevent the drop.
If you recently ate a high-fat or high-protein meal, your gastric emptying is already slowed by the food itself. Adding a GLP-1 on top of that means a low could take a very long time to come up. In these cases, liquid glucose is generally your best option.
My Favorite Fast-Acting Low Blood Sugar Treatments
There is nothing scarier than having an urgent low that won’t come up, and you may see this happen more often when on a GLP-1. When you are on a GLP-1, you want to keep low treatments on hand that bypass the “slow stomach” as much as possible. i always make sure to have some of these options in my car, my purse, and near my bed at all times and always take a few with me when I’m out walking or at the gym.
These are my go-tos for fast, reliable low blood sugar treatment:
- Transcend glucose gels: These are specifically formulated to be absorbed quickly and are easy to carry in a purse or gym bag.
- Glucose tablets: The classic choice for a reason. They are pure dextrose and act much faster than candy or snacks.
- Elovate 15: These glucose slim packs are powdered and dissolve almost instantly, making them a great option for on-the-go or middle-of-the-night lows.
- Glow gummies: These are my new favorite! If you prefer a chewable option, these are a great way to get a precise dose of glucose, and they actually taste really good too.
In Summary
Navigating low blood sugar while on a GLP-1 requires a shift in mindset. You have to be more proactive in catching the “slow drifts” and more patient when waiting for a rise. The key is to avoid the panic-eating cycle by using fast-acting glucose products that work with your body’s slowed digestion, rather than against it.
As always, keep a close eye on your CGM patterns and discuss these trends with your diabetes care team. They can help you adjust your basal rates, sensitivity factors, and insulin-to-carb ratios to better reflect your new, higher level of insulin sensitivity.
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