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Karen Chapman Novakofski

Professor of Nutrition

Marilyn Csernus

Extension Educator, Nutrition and Wellness


February-March 2019

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In This Issue
  • Diabetes - the Medical Perspective
  • Diabetes and Food
  • Recipes to Try
  • Menu Suggestions

Hypoglycemia Unawareness

Hypoglycemia happens when blood glucose drops below 70mg/dl. Most people recognize low blood glucose symptoms, and get relief of these symptoms after eating a fast-acting carbohydrate. Individuals taking insulin or some type 2 diabetes medications are at risk of hypoglycemia.

Severe hypoglycemia occurs when blood glucose falls to a level that requires someone else to help with treatment because of altered mental status.

Usually when hypoglycemia occurs, there are a variety of recognizable symptoms such as shakiness, sweating, anxiety, heart palpitations, irritability, and dizziness.  With hypoglycemia unawareness, blood glucose drops without these typical warning symptoms. This condition is caused by a failure of glucose counter regulation.

 Frequent episodes of hypoglycemia can cause increasingly lower levels of glucose to produce symptoms. In some cases, these warning symptoms are not present at all.

Hypoglycemia unawareness is more common with type 1 diabetes because of the dependence on insulin. The longer the duration of diabetes, the greater the risk of hypoglycemia unawareness.

The absence of hypoglycemia symptoms presents a danger for the person with diabetes. This can be especially concerning if it happens during sleep, or when one is driving. It is also a difficult management issue for the health care provider.

Treatment for hypoglycemia unawareness is avoiding low blood glucose.  Start with identifying the blood glucose level that triggers hypoglycemic symptoms.  Work with your health-care provider to modify glucose and A1C targets to prevent hypoglycemia. The longer hypoglycemia is avoided the better. It can help restore the blood glucose response.

Technology can play an important safety role. Wearing a continuous glucose monitor that alarms as glucose levels drop too low will alert you to the developing hypoglycemia. Some devices can send alerts to loved ones as an additional safety measure. This safety measure provides another level of comfort for parents of children with type 1 diabetes. Some insulin pumps will suspend insulin delivery when glucose drops too low.

Diabetes and Food

Keeping a daily record of physical activity, food intake, and insulin administration can help pinpoint causes of hypoglycemia.  A careful review of carbohydrate intake may identify areas of your meal plan that need to be updated. Diabetes is a progressive disease requiring periodic review of your meal plan and medication. Share your record keeping with your health-care provider and registered dietitian to fine-tune carbohydrate counting and/or carb-to-insulin ratios.


Tips for preventing hypoglycemia:


  1. Work with your health-care team to set or update target blood glucose ranges.
  2. Understand when your insulin or other medication peaks.
  3. Check blood glucose as instructed by your health-care provider.
  4. Never go to sleep without a snack if your blood glucose is below your individual target level.
  5. Check blood glucose before exercising or driving and treat as appropriate.
  6. Eat regularly scheduled meals and snacks.
  7. Keep fast-acting carbohydrate handy.

Remember the 15/15 rule to treat hypoglycemia. If blood glucose is below 70 mg/dl eat or drink 15 grams of fast-acting carbohydrate. Wait 15 minutes and recheck blood glucose. It takes about 15 minutes to feel better despite the amount of carbohydrate consumed. If still low, treat with an additional 15 grams of fast-acting carbohydrate. If no meal or snack is planned follow-up with a glucose check one hour after treatment. 

Seek medical advice if unable to effectively treat and maintain a safe blood glucose level.

Sources of fast-acting carbohydrates:

  1. 4 ounces of juice
  2. 4 ounces of regular soda
  3. 5-6 Lifesavers
  4. 3-4 Glucose tablets
  5. 15 gram tube of glucose gel or liquid


Hypoglycemia unawareness can be a challenging and dangerous condition. Careful monitoring and prevention of low blood glucose can help restore your ability to recognize and treat the symptoms.   




Recipes to Try

Baked Parmesan Perch

Italian Turkey Casserole

2 servings per receipe


  • 8 ounces perch fillets, thawed
  • ½ cup bread crumbs, plain
  • ¼ cup skim milk
  • ½ teaspoon rosemary
  • 1 tablespoon Parmesan cheese
  • Cooking spray


    1. Preheat oven to 450°F.  Spray shallow baking pan with cooking spray.
    2. Combine Parmesan cheese, bread crumbs, and rosemary. Dip fillets in milk, then roll in bread crumb mixture.
    3. Place fillet in pan and bake for 15-20 minutes or until fish flakes easily with fork.
Nutrition Facts per serving
Calories 232
Fat 3 grams
Protein 27 grams
Calories from fat 27
Carbohydrate 21 grams
Cholesterol 105 mg
Fiber  365 grams
Sodium 365 mg
This and other recipes available at http://urbanext.illinois.edu/diabetesrecipes/intro.cfm

Chicken Stew

Italian Turkey Casserole

6-1 cup servings


  • 8 chicken pieces (4 pounds chicken total, breasts or legs)
  • 1 cup water
  • 2 small garlic cloves, minced
  • 1 small onion, chopped
  • 1½ teaspoons salt
  • ½ teaspoon pepper
  • 3 medium tomatoes, chopped
  • 1 teaspoon parsley, chopped
  • ¼ cup celery, finely chopped
  • 2 medium potatoes, peeled and chopped
  • 2 small carrots, chopped
  • 2 bay leaves


  1. Remove the skin from the chicken and any extra fat.  In a large skillet, combine chicken, water, garlic, onion, salt, pepper, tomatoes, and parsley.  Tightly cover and cook over low heat for 25 minutes.


  1. Add celery, potatoes, carrots, and bay leaves and continue to cook for 15 more minutes or until chicken and vegetables are tender.  Remove bay leaves before serving.
Nutrition Facts per serving
Calories 315
Fat 3 grams
Protein 55 grams
Calories from fat 27
Carbohydrate 13 grams
Cholesterol 137 mg
Fiber 2 gram
Sodium 605 mg
This and other recipes available at http://urbanext.illinois.edu/diabetesrecipes/intro.cfm

Sample Menu


Amount/ Portion

Hard Cooked Egg

1 egg


 ½ cup

Fresh Blueberries

¾ cup

Chopped walnuts

¼ cup

Skim Milk

1 cup

569 Calories; 60 Grams Carbohydrate; 4 Carbohydrate Choices


 Non-Fat Greek Yogurt

5 ounces

 120 Calories; 15 Grams Carbohydrate; 1 Carbohydrate Choices



Baked Parmesan Perch

1 serving

Brown Rice

2/3 cup

Steamed Broccoli

1 cup

Soft Tub Margarine

1 teaspoon

467 Calories;  60 grams Carbohydrate;  4 Carbohydrate Choices


Whole Wheat Crackers


Lite String Cheese

1 stick

130 Calories; 15 Grams Carbohydrates; 1 Carbohydrate Choice



Chicken Stew

1 serving

Tossed Green Salad

1  cup

Balsamic Vinaigrette 

2 tablespoons

Yogurt Berry Parfait

1 serving

585 Calories; 50 Carbohydrates; 3 Carbohydrate Choices




¾ cup

Skim Milk

1 cup

165 Calories; 27 grams Carbohydrates; 2 Carbohydrate choices

Total: 2036 Calories; 228 Grams Carbohydrate;15 Carbohydrate Choices