Diabetes: Low Blood Sugar (Hypoglycemia)

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KEY POINTS

• Hypoglycemia means that your child’s blood sugar (glucose) level is abnormally low. If blood sugar is too low and not treated right away, your child could pass out, have a seizure, go into a coma, or even die.
• Quick treatment is to give some kind of sugar as fast as possible. Your child should always carry some form of sugar that he can eat as soon as he has any symptoms of low blood sugar. If symptoms get worse despite treatment, call your child’s healthcare provider or 911.

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What is low blood sugar?

Hypoglycemia means that your child’s blood glucose (sugar) level is abnormally low. If your child's blood sugar is too low and not treated right away, your child could pass out or even have a seizure. The brain could be harmed. Because the brain grows very quickly in the first 4 years of life, it’s very important to prevent very low blood sugar in young children. For most children, a low blood sugar is less than 70 mg/dL. However, each person is different and your healthcare provider may recommend that your child treat low blood sugar at a different level.

Everyone taking care of your child needs to know the signs and symptoms of low blood sugar so it can be treated right away.

The medical term for low blood sugar is hypoglycemia. If your child is taking insulin, it is sometimes called an insulin reaction or insulin shock.

What is the cause?

Low blood sugar is usually a side effect of diabetes treatment. When a child has diabetes, low blood sugar can be caused by too much insulin or other diabetes medicine. If your child is using insulin, it may happen because:

• Too much or the wrong type of insulin has been given.
• Your child has an insulin pump that is not attached properly or not working.

Some other things that can cause an abnormally low blood sugar level when a child has diabetes are:

• Exercising more than usual
• Skipping or delaying meals or snacks
• Having a meal or snack that is too small
• Dieting to lose weight
• Not taking diabetes medicines at the right time
• Side effects of other medicines
• Drinking alcohol
• Diarrhea or vomiting
• Problems caused by tumors or lack of hormones
• Severe kidney or liver disease
• Taking a bath or shower or soaking in a hot tub soon after taking a shot of insulin (blood vessels in the skin get larger from the hot water and cause insulin to be absorbed more quickly)

What are the symptoms?

It is important to recognize low blood sugar as soon as possible, before it gets dangerously low and causes a severe reaction.

Symptoms may include:

• Shakiness
• Hunger
• Nervousness, or anxiety
• Grumpiness or irritability
• Sweating or chills
• Lightheadedness
• Nausea
• Headache
• Fast pulse
• Confusion (feeling or looking dazed)

For some children, a blood sugar below 90 mg/dL can cause these symptoms. For others, symptoms may not start until the blood sugar level is below 70 mg/dL.

You may be able to help your child learn to recognize the signs of low blood sugar. You may tell a young child, for example: "Remember how you felt shaky and you came and told me? You did a good job! Remember to tell a grownup if you feel that way again."

If low blood sugar happens during the night, your child may sleep through it or your child may wake up with sweating, a headache, a fast heart rate, or feeling foggy headed. Babies may cry. If your child wakes up with any of these signs of low blood sugar, test and treat the blood sugar right away. Also think about what was different the previous day (like extra exercise, extra insulin, or less food). This will help you learn how to keep it from happening again. Keep a record of these reactions. It may help to test your child's blood sugar right before bed and to give a snack if the blood sugar is low.

How is it treated?

Insulin reactions happen quickly and should be treated at once. The general rule is to give some kind of sugar as fast as possible.

Your provider will give you guidelines for treating low blood sugar when your child is having symptoms. Here are some examples of guidelines your child’s provider may give:

• If you think your child’s blood sugar may be too low, check it with your home glucose meter before giving treatment, if possible.
• Always carry some form of sugar your child can eat as soon as he or she has any symptoms of low blood sugar. Each of the following amounts and types of food are about 15 to 20 grams of glucose or simple carbohydrates and should bring the blood sugar level up quickly:
  • 3 to 4 glucose tablets
  • 1/2 cup (4 oz) fruit juice
  • 1/2 cup (4 oz) regular (not diet) soda
  • 8 ounces of skim milk
  • 2 tablespoons of raisins (about a palm full)
  • 5 to 7 pieces of hard candy like Lifesavers
  • A tube of glucose in gel form
  • 1 tablespoon of molasses, corn syrup, or honey
• If your child still has symptoms 10 to 15 minutes after eating or drinking one of the foods listed above, your child may need to eat or drink another portion.
• If your child is about to eat a meal, he or she should eat the fruit or drink the juice first and then eat the rest of the meal.
• After 15 minutes, check your child’s blood sugar again. If it is still low, your child should have another serving of one of the foods on the list. Repeat these steps until the blood sugar is in the range recommended by your healthcare provider (usually above 70) or until your child feels better. Your child may need to eat a protein snack (like peanuts, peanut butter, or cheese) or meal soon after he or she feels better to keep the blood sugar from getting too low again.
• Your child should rest at least 10 minutes after eating and repeat the blood sugar test to make sure it is in the right range before returning to normal activity.

If your child’s symptoms get worse despite treatment, call your child’s healthcare provider or 911. If your child passes out, call 911 to get help on the way before checking for or treating low blood sugar. Emergency treatment may include medicine to raise your child’s blood sugar. Your child may need to go to the hospital to be treated with IV glucose.

Your child’s healthcare provider may tell you to keep glucagon on hand. It makes the blood sugar rise quickly. It can be given as a shot by a family member when your child is having low blood sugar and is not alert enough to safely take some food.

If your child often has symptoms of low blood sugar, see your child’s healthcare provider. When you see your child’s provider, be sure to take the records of all of the results of recent blood sugar checks. This helps your child’s provider know if your child is on the right medicines and is taking the right doses at the right times of day. Without this record, it’s harder for your provider to help you figure out the cause of the symptoms and to prescribe the best treatment plan and schedule for your child.

How can I take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Know when to check your child's blood sugar and when to call for help.
• Check your child's blood sugar more often when your child is exercising more or eating less, or when your child is sick, according to your provider's instructions.
• Make sure your child carries sugar he can eat if his blood sugar gets too low. Sugar tablets are good for emergencies.
• Recheck the blood sugar 20 to 30 minutes after treatment for low blood sugar to make sure it goes back up (especially at bedtime or during the night).
• Have your child carry a medical ID (such as a card or bracelet) that says your child has diabetes.
• Teach others who care for your child how to give a shot of glucagon, if it has been prescribed for your child.

Ask your provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent low blood sugar?

You can help prevent low blood sugar if you:

• Check your child's blood sugar level regularly.
• Help your child learn his symptoms of low blood sugar so that he can treat it right away.
• Know what causes low blood sugar.
• Make sure your child eats regular meals. Don’t let your child delay or skip meals or eat partial meals.
• Have your child eat snacks before heavy physical exercise and at the time of day when there have been previous reactions.
• When your child is going to do all-day exercise, like hiking or skiing, lower the insulin dose according to your healthcare provider's instructions, do extra blood sugar tests, and have your child eat extra snacks.
• Be careful to give shots of insulin after a shower or bath and not before.
• Check your child’s blood sugar more often when your child is exercising more or eating less, or when your child is sick, according to your healthcare provider's recommendations.
• Keep follow-up appointments with your child’s provider and take the glucose meter or sugar log to show your provider at the checkups.