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At the first signs of a low blood sugar, do your shaking hands reach for the Skittles or for proper fast-acting emergency glucose? And if so, in what format — gel, liquid, or tabs?
Did you know there is another option: powder packets made specifically to treat hypoglycemia (low blood sugar)?
There are currently two glucose powder products on the market, and we recently tried them both. But before we get into our review, let’s talk “proper glucose” for a moment.
We regret to inform you that Skittles aren’t proper glucose. Why is that?
Because in fact, no candy is. Commercial sweets are made from sucrose or fructose, which are chemically distinct from glucose — the sugar that fuels the human body. Glucose is the only substance that can directly reverse a low blood sugar, as both sucrose and fructose need to be converted into glucose by your digestive system before they can reverse a low.
Sure, industrial sugar products will work in a pinch, but they’re slower because there’s an extra step involved. Plus, consumer sweets also contain a gambit of other ingredients, such as fiber, proteins, and fats, which can slow down the digestion process, leading to yet more delay in reversing a low blood sugar, or lead to inconsistent results.
The traditional form of emergency glucose is the ubiquitous glucose tablet. Historically, they were chalky, tasted awful, and were bulky to carry, leaving a market opportunity for a new alternative.
One of the first to fill this niche was the Dex4 liquid shot. It worked fast, didn’t leave your mouth full of chalk, and didn’t taste at all bad. That said, it’s hardly pocketable, and some people have a hard time getting the bottles open, especially when they are low, as hypoglycemia tends to trash your dexterity.
Next came gel packet products such as the now now-defunct Level Life products that became the popular Transcend. Gel packs are slim and thin, if somewhat long, “pocketable” pouches. The material is a remarkably robust soft plastic, allowing a packet to be carried in the front pocket of pleasantly tight-fitting jeans for months.
Like pretty much every other product in the class, powered glucose is made from dextrose (another name for glucose). In this case, it’s dextrose that’s been milled into an incredibly fine power. This fine milling is intended to make the dextrose quick to absorb, with some of it entering your bloodstream directly through the mucous membranes in your mouth — which it does — although how much of the sugar actually reaches the rest of your body from there is
Powered glucose is packaged in foil paper envelopes reminiscent of Kool-Aid packets, only much fatter, and they appear invulnerable to melting or freezing. They also have a long shelf life and are relatively economical, at least compared to some of the other glucose products on the market. Glucose powder is currently sold by two companies under the respective brands of Glucose SOS and Elovate 15.
Powdered glucose isn’t unique, as it has been around for years in some form.
But the modern iteration at the foundation of both current products was pioneered in the trenches by D-Mom Pamela Heyward of Georgia, who had a hand in both the companies that make and market glucose powder. She is now only actively involved with Glucose SOS.
The backstory is that two of her four kids have type 1 diabetes, and when they were little, she was dissatisfied with the emergency glucose options on the market. Being a champion of healthy eating, she refused to go the pocket-full-of-candy route.
She was also concerned about the excess calorie load that candy-as-medicine imposes on the body, leading to weight gain, which in turn makes diabetes control more challenging; so she undertook a years-long quest to come up with something better.
Glucose SOS is a brand name of Advocate Pharma Supply, a Florida-based company that sells glucose meters and test strips, lancets, syringes, pen needles, and diabetes foot cream. They also sell glucometers for diabetic animals and “pet” insulin syringes for U-40 veterinary insulin.
The Glucose SOS packet is a small (3 inch by 4 inch) slick paper sack with an almost invisible slit on either side of the top to facilitate tearing the pouch open easily. This is indeed easy to do, but leaves a wide open, gaping maw of a mouth, revealing a frightening volume of fine powder in the pouch. More on that later.
Here’s the skinny on this product:
- Concentration: 15 grams total carbohydrate.
- Calories: Not stated.
- Pricing: $10.99 for a six-pack at Advocate’s website, may be lower elsewhere.
- Flavors available: Original Sweet & Tangy, Fruit Medley, Green Apple Crisp, Kiwi-Strawberry.
- Where to buy: Amazon, and directly from Advocate.
- Sizes: Boxes of six packets.
- Also available: A meat stew-flavored gel version, in a syringe, for pets with diabetes (no kidding).
Oh, and it’s worth noting that a percentage of all Glucose SOS sales go to the Help a Diabetic Child Foundation.
The box we purchased at Amazon had an expiration date of June 2022. It was the Sweet & Tangy flavor, which — dipping a finger into the powder — I found it to be so mild as to almost have no flavor at all.
Elovate 15 is distributed by the Utah-based Diasan Corporation (not to be confused with the diabetes feeding tube product Diason). Elovate 15 glucose powder is Diasan’s only product. The packet has a slightly smaller overall footprint than the competition, but is also a bit thicker. The company bills it as an “Easy Carry Slimpak,” but it wouldn’t fit most people’s definition of slim.
Like the competition it can also be ripped open from either side of the top. But thanks to robust double notches on the foil-paper bag, it is even easier to open than the Glucose SOS. The difference is subtle, but we found the Elovate 15 powder to be a bit finer than the Glucose SOS product.
Here are the product particulars:
- Concentration: 15.5 grams total carbohydrate.
- Calories: 62 per packet.
- Pricing: $8.99 for six slimpacks purchased directly from Diasan, lower elsewhere.
- Flavor: Natural Black Cherry only.
- Where to buy: Amazon, Staples, Grainger, eBay, and direct from Diasan.
- Sizes: Six-pack boxes, bulk boxes of 50 slimpacks, and cases of 144 slimpacks.
The box we purchased at Amazon had an expiration date of September 2022. Sampling a small amount, I found the flavor to be tasty, and not too medicinal, as happens with some cherry-flavored medical products.
Truth be told, it’s been quite a while since I’ve had a low. The combination of a low-carb diet and the Tandem Control-IQ pump has kept me nicely on the rails, so to test these products I actually had to induce a low by intentionally delivering an extra bolus dose of insulin on an empty stomach.
I had hoped to drop to 65 mg/dL for the test, but after hours of shaky hands and questionable internet shopping while hovering at a glucose level the mid 70s, I broke out the powder. I chose to use Glucose SOS first for the test, and held a packet of Elovate in reserve in case the one packet of SOS didn’t do the trick.
I ripped open the packet and poured the entire contents into my mouth. Whereupon I coughed half of it out onto the floor. What stayed in my mouth, while still a large volume, dissolved with the oddly magical speed of cotton candy. Not having ingested a full dose, and not wanting to lick the floor, I tried the same thing with the Elovate 15, with the same results. For what it’s worth, in large quantities the Glucose SOS still has little flavor, and the Elovate 15, in larger quantities, actually does have that nasty cough syrup aftertaste.
Of course, I failed to read the Glucose SOS directions, which state:
- Tear open packet.
- Tap powder in mouth in small amounts.
- Repeat until contents of packet are empty.
Still, this is one weakness of the product. You can guzzle down a Dex4 liquid shot in a couple of gulps. It’s only 1.8 ounces of liquid. And you can quickly (and relatively discretely) slurp down a gel pouch’s contents. The powder, by comparison, takes a lot of work. There’s ripping open the packet without jettisoning the powder all over the floor, and the considerable task of masticating the powder without making a mess drooling.
In 5 to 6 minutes, the shaking hands had resolved. In 15 minutes, my BG had risen from a low of 74 to 79. In half an hour, I was at 150 BG with two arrows up showing on my CGM. At three-quarters of an hour, I was at 207 with two arrows up. Within a full hour, I was at 218 with one arrow up. Just shy of two hours, I crested at 274 and broke out the insulin again. Given that I can’t say how much powder fell on the floor, it’s hard to say if I over-treated or over-responded.
Later, I experimented with trying to shape the open bag into a narrow spout, but still found that I spilled as much on my face as I got in my mouth.
For a reality check, I gave a couple of packets to one of my hypo-prone diabetes sisters, and she reported that the powdered glucose “works fast.” She saw a nocturnal jump from sub-70 to 150 in 30 minutes, and said, “I could feel it working within minutes in my predawn daze.” She also reported, “Luckily the powder made it to my mouth instead of to the bed,” but then admitted, “I haven’t checked that closely.”
An alternative strategy for dosing is mixing the glucose powder with water, an idea actually suggested on the Elovate 15 packet. I poured one packet of powder into water and it dissolved almost immediately. Which, of course, turned it into liquid, which defeats the alleged purpose of glucose powder. It’s not that easy to carry if you also need to pack a water bottle, nor is it fast if you have to stop to mix it.
Post-use both packets were messy, poofing out small clouds of leftover ultra-fine glucose powder, which I found to be resistant to clean-up. The powder leaves a glucose haze on surfaces and floors, despite repeated mopping.
Finally, although I didn’t have the chance to carry either packet for many months, the material seems less durable to repeat carry than those leather-tough gel pouches, and the packet is no thinner. They may be more durable than they look, but if they fail, you’ll have a pocket (or purse) full of powder, rather than a pocket full of goo. Pick your poison, as they say.
Even a bit at a time, either a Glucose SOS or an Elovate 15 packet is a whole lot of powder to put in your mouth. And I can’t imagine using it in the middle of the night when fighting both the cognitive confusion of sleep and hypoglycemia.
Additionally, powdered glucose is messy under the best of circumstances and would be a nightmare outdoors on a windy day. It takes longer to consume, compared to other options (tablets, liquid, gel), but it does seem to hit the bloodstream faster.
That said, my two cents are that this product needs a better method of dispensing — then it could well become a category killer and the go-to emergency glucose for most people with diabetes. In the meantime, it seems best suited for those who find that their systems respond too slowly to tabs, shots, or gel.
Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.