Minimizing Hypoglycemia Using a Five-Step Diabetes Managemen
Hypoglycemia is a serious complication for people with diabetes who are on medications such as sulfonylureas and insulin. Severe hypoglycemia can lead to seizures, declined cognitive function, cardiovascular events, and even death. Impaired awareness of hypoglycemia (IAH) makes matters much worse.

Five-Step Program to Aid Diabetes Management:
1. Pay Attention to Meal Timing- Most people would benefit from eating a moderate breakfast, regular lunch, and light, early supper (all else being equal). This is because glucose tolerance is poor in the evening for most of us, and this type of eating pattern is in phase with the body’s circadian clock. People with diabetes have poor glucose tolerance in the morning, as well. Adding a high-protein low-carbohydrate pre-breakfast snack 90–120 minutes before breakfast provides a second-meal effect, moderating the post-meal glucose surge.
2. Meal Composition- improves when fiber, lean protein, non starchy vegetables, and healthy fats are added to appropriate carbs. Carb intake should be lowered if post-meal glucose is >180 mg/dL. When meal composition improves, glucose is absorbed slowly, glucose surges are wider, and glucose variability is lower, leading to minimal hyperglycemia and hypoglycemia.
3. Nutrient Sequencing-eat protein and vegetables first and then eat carbohydrates or dessert 10–30 minutes later
4. Pre-Meal Walk- High-intensity pre-breakfast exercise offers multiple benefits, including the absence of hypoglycemia during the activity, a delayed insulin sensitivity improvement that lasts for 24 hours or more, and better FBG. It also generates post-exertion hyperglycemia, leading to glucose dysregulation for 1–3 hours.
5. Post-Meal Walk- A 30-minute post-meal walk after any big meal would blunt the glucose surge in real time.