Diabetes: Low Blood Glucose (Hypoglycemia)

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KEY POINTS

• Hypoglycemia means that your child’s blood glucose (sugar) level is abnormally low. If blood glucose 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 glucose as fast as possible. Your child should always carry some form of glucose to treat any symptoms of low blood glucose. If symptoms get worse despite treatment, call your child’s healthcare provider or 911.

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What is low blood glucose?

Hypoglycemia means that your child’s blood glucose (sugar) level is abnormally low. If your child's blood glucose 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 glucose levels in young children. For most children, a low blood glucose level is less than 70 mg/dL. However, each person is different, and your child’s healthcare provider may advise treating low blood glucose at a different level.

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

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

What is the cause?

Low blood glucose is a possible side effect of diabetes treatment. When a child has diabetes, low blood glucose 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 correctly.

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

• More physical activity 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 or interactions with 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, because 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 a low blood glucose level 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 as in feeling or looking dazed

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

You may be able to help your child learn to recognize the signs of low blood glucose. 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 glucose 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 glucose, test and treat the blood glucose right away. Also think about what was different the previous day such as having extra physical activities, 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 glucose level right before bed and to give a snack if the blood glucose is low.

Help your child prevent low blood glucose because very low blood glucose that occurs often can cause long-term problems with your child’s ability to remember, pay attention, make decisions, or make sense of what is seen or heard.

How is it treated?

Insulin reactions happen quickly and should be treated right away. The general rule is to give glucose as fast as possible.

Your provider will give you guidelines for treating low blood glucose 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 glucose may be too low, check it with your home glucose meter before giving treatment, if possible.
• Always carry some form of glucose to treat any symptoms of low blood glucose. Each of the following amounts and types of food are about 15 to 20 grams of glucose or simple carbohydrates (carbs), and should bring the blood glucose level up quickly:
  • 3 to 4 glucose tablets
  • 1/2 cup (4 ounces) fruit juice
  • 1/2 cup (4 ounces) full-sugar soda
  • 1 cup (8 ounces) of skim milk
  • 2 tablespoons of raisins (about a palm full)
  • 5 to 7 pieces of chewy candy
  • A tube of glucose in gel form
  • 1 tablespoon of molasses, corn syrup, or honey
• If your child still has symptoms 15 minutes after eating or drinking one of the foods listed above, your child may need to eat or drink another portion.
• When having a meal, your child 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 glucose level 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 glucose level is in the target range as advised by your child’s healthcare provider (usually above 70) or until your child feels better. Your child may need to eat a protein snack such as peanuts, peanut butter, or cheese, or a meal soon after your child feels better to keep the blood glucose from getting too low again.
• Your child should rest at least 10 minutes after eating and recheck your child’s blood glucose level 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 glucose. Emergency treatment may include medicine to raise your child’s blood glucose level. 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 glucose rise quickly. It can be given by a family member when your child is having low blood glucose and is not alert enough to swallow safely. Your child’s other family members should also know how to use your child’s glucose meter to check your child’s blood glucose levels when you or your child are not able to.

If your child often has symptoms of low blood glucose, 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 glucose 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.

Ask your child’s healthcare provider about training programs that teach how to be aware of symptoms, and ways to prevent hypoglycemia. Training is also available for how to stay in the target range for blood glucose by balancing what your child eats and drinks with the amount of insulin your child gets. A continuous glucose monitor (CGM) device can help prevent hypoglycemia because it displays the glucose level all the time or on demand.

How can I take care of my child?

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

• Know when to check your child's blood glucose levels and when to call for help.
• Check your child's blood glucose levels more often when your child is more physically active or eating less, or when your child is sick, according to your provider's instructions.
• Make sure your child carries glucose to take if blood glucose levels get too low. Glucose tablets or gel are good for emergencies.
• Recheck the blood glucose level 15 minutes after treatment for low blood glucose 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 when and how to give glucagon if it has been prescribed for your child.

Ask your child’s provider:

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

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

How can I help prevent low blood glucose?

You can help prevent low blood glucose if you:

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