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Treat Lows with High GI

As we discussed in An Introduction to the Glycemic Index, a food’s Glycemic Index (GI) value is relevant in terms of choosing effective treatments for low blood glucose.

A food with a high glycemic value (such as Sweet Tarts®, Rockets® candy, and Gatorade®) will raise blood glucose faster than a food with a lower GI value (such as fruit juice or cola).

 
 
 
 
raises blood sugar faster than

Some examples of foods and drinks typically used to treat low blood glucose are given in the table below. Where does your child’s usual low treatment fall?

Typical Low Treatments GI Value 
Glucose Tablets 100
Rockets®, Sweet Tarts® 100
Nerds® 100
Gummies(with glucose syrup) 94
Jelly Beans 80
Licorice 78
Skittles 70
Life Savers 70
Marshmallows 63
Gatorade 89
Orange Pop 68
Kool-Aid Jammers® 55 (estimate)
Coke 53
Juice 41
Chocolate Milk 37
 

When your child is experiencing a low, you want to bring their blood glucose up as rapidly as possible. To do this, use the fastest-acting sugar available (that is also easy to consume). Therefore, when you have low treatments from a range of GI values to choose from, it is wise to choose high GI foods/liquids over lower GI alternatives, thereby raising blood glucose back up to target more quickly.

Glucose/dextrose is the fastest-acting sugar available; ingredients listed as “sugar” are next; fructose is the slowest-acting sugar. So:

A good rule of thumb is to look for a low treatment that has glucose or dextrose as the primary ingredient (or no further than 3 from the top of the ingredient list). The closer dextrose is to the top of the ingredient list, the more quickly it will raise blood glucose. For example, marshmallows usually rank around 63 on the glycemic index, but there are a few brands that contain dextrose (in addition to the usual: corn syrup and sugar). The addition of glucose will bump marshmallows up on the glycemic scale, thus these brands will raise blood glucose more quickly than those without glucose. This is also true for juice, gummies, licorice, etc.: different brands will contain different sweeteners in differing quantities, so look for glucose or dextrose as one of the top ingredients.

But We’ve Always Used Juice to Treat Lows!

This is not to say that lower GI foods and drinks cannot be used as low treatments, only that the delayed effect on blood glucose should be taken into account before providing a second low treatment for the same episode.

If treating a low blood sugar with a substance that is on the lower end of the GI scale (like juice), you may want to allow for more time for that food to increase blood sugar. If you wait longer than 15 minutes before rechecking blood glucose, you will be more likely to see the real effect of the low-GI food; if you recheck blood glucose too soon, you may assume the amount of low treatment consumed is not enough, and so may take even more sugar to counteract the low, resulting in over-treatment of the low (and probable high blood sugar later, that you will correct with insulin, that may cause another low, etcetera, etcetera, etcetera).

Also, keeping the delayed effect in mind, it is wise to choose a low treatment with high dextrose content when your child’s blood glucose less than 3.0 mmol/L, or if they are displaying signs of a moderate low (confusion, poor coordination, slurred or slow speech, etc). In these instances, it is even more critical to raise blood glucose quickly.

With that being said, individual response to different low treatments does vary. And the best low treatment is the one that your child will actually eat or drink. So we recommend that you consider your options and do what works best for your family.

Unconventional Low Treatments

So what about saltine crackers and those breakfast cereals that seem to raise blood glucose before your child even sits down to breakfast? Those are high on the glycemic index, so wouldn’t they also work as low treatments?

Yes. And no.

You also need to consider how easy a food is to consume. Liquids tend to be consumed easily for many kids, while dry, crumbly, hard to chew, or hard to swallow foods can pose logistical issues, even if in theory they seem appropriate to raise blood glucose.

Tips from the Trenches

We have tried using more unconventional low treatments such as Unsalted Premium Plus crackers, pretzels, white bread or cereal such as Corn Pops. While they did work well at raising blood sugar, they usually involved Paul eating a substantial amount to meet the proper carb requirement and he complained that they were very dry and difficult to eat quickly. We usually use these things, just to add variety, when fast carbs are required for exercise (versus treating a low). For lows, we still turn to things like gummies, Nerds® and Rockets®. ~Danielle

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

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