1. Carlson, Julia A. MBA, BA, BS
  2. Craven, Kay MPH, RDN, LDN, CDE
  3. Kolasa, Kathryn PhD, RDN, LDN


Approximately 80% of people with type 2 diabetes mellitus are obese and are encouraged to lose weight by increasing physical activity and controlling dietary intake, while maintaining optimal glycemic control. Physical activity and diet, along with medication, will have an impact on an individual's daily blood glucose fluctuations. Healthcare providers evaluate patient glycemic control by measuring hemoglobin A1c. Providers often work with patients with type 2 diabetes mellitus to achieve a hemoglobin A1c level less than 7% to achieve better overall health outcomes; however, a serious complication of working toward that goal-sometimes referred to as "tight glycemic control"-can be hypoglycemia. Hypoglycemia typically is treated by the patient consuming carbohydrate. This strategy can have unintended consequences for patients who are already overweight or obese. In this article, we present a case from our clinic to describe how a patient trying to follow her type 2 management plan developed a fear of hypoglycemia and adopted behaviors that had unintended consequences. We present evidence-based strategies for treating hypoglycemia with a carbohydrate food or beverage.