Patient education: Low blood sugar in children with diabetes (The Basics)

What is low blood sugar? — 

This is when the level of sugar in the blood gets too low. It is also called "hypoglycemia."

In children, low blood sugar can cause symptoms ranging from sweating and acting cranky to passing out.

Low blood sugar can happen in children with diabetes.

When can people with diabetes get low blood sugar? — 

Children and teens with diabetes can get low blood sugar when they:

●Take too much insulin

●Do not eat enough, or wait too long between meals

●Exercise too much without eating a snack or reducing their insulin dose

●Are sick, especially if they are vomiting

For teens and young adults, drinking alcohol can cause low blood sugar.

Low blood sugar can happen in people of any age. But it is more common in younger children. That's because it can be harder to predict their eating and exercise habits.

What are the symptoms of low blood sugar? — 

In children, common symptoms of low blood sugar can include:

●Acting cranky, tired, or not eating (especially in younger children)

●Shaking

●Sweating

●Feeling weak, tired, nervous, or hungry

●Nightmares, or poor sleep

●Confusion

If low blood sugar is not treated, it can lead to more serious symptoms, such as seizures or coma.

Some children do not get symptoms during the early stages of low blood sugar. This is sometimes called "hypoglycemia unawareness." Children and teens with hypoglycemia unawareness might not know they have low blood sugar until they have severe symptoms. This is more common in children and teens who have had diabetes for years.

How is low blood sugar treated? — 

It can be treated with:

●Quick sources of sugar – Examples include fruit juice, regular (not diet) soda, honey, candy, table sugar, or glucose tablets or gel (table 1). Older children and teens can learn to recognize the early symptoms of low blood sugar and treat it right away. Children or their caregivers should carry a quick source of sugar at all times. School or day care staff should also be prepared to treat low blood sugar if needed.

●A dose of glucagon – This is a hormone that can quickly raise blood sugar levels and stop severe symptoms. It comes as a shot or a nose spray. It can be used if the person cannot eat or drink a quick source of sugar.

Your child's doctor will teach you and your child how to use glucagon. The child should also have a glucagon kit at school or day care.

After treating low blood sugar, it is very important to recheck your child's blood sugar level to make sure it rises and stays in the normal range. Depending on how your child takes insulin, they might need to eat a small snack that contains protein, fat, and carbohydrates. This can help keep their blood sugar stable.

What should my child do after treatment? — 

Most children can get back to their usual routine. But the doctor or nurse might recommend checking the child's blood sugar level more often during the next 2 to 3 days.

Tell the doctor or nurse if your child has an episode of low blood sugar. They will discuss your child's treatment plan and whether it should be changed.

How can I prevent low blood sugar? — 

You should:

●Check your child's blood sugar levels often – The doctor or nurse will tell you how and when. They will also tell you what your child's blood sugar levels should be.

Your child's doctor can also talk to you about "continuous glucose monitoring," or "CGM." With CGM, the child wears a special sensor with a tiny plastic tube that goes under their skin. The sensor measures the sugar in the fluid under their skin. Then, it sends the information to a small box or to a smartphone app. CGM devices can give an alert or alarm if their blood sugar gets too low. Some types of insulin pumps have a CGM built in. This way, the pump can be programmed to adjust the insulin dose if the child's blood sugar gets too low.

●Learn the symptoms of low blood sugar, and be ready to treat it right away – Treating low blood sugar early can prevent severe symptoms. Older children can also learn how to recognize the symptoms and treat low blood sugar themselves.

It's important to see the diabetes doctor or nurse regularly. The doctor or nurse will ask about symptoms and adjust the treatment plan if needed.

When should I get emergency help? — 

Take your child to the emergency department or call for an ambulance (in the US and Canada, call 9-1-1) if they:

●Still have low blood sugar after treatment

●Are not acting normally after treatment

●Passed out, and no one can give them glucagon

More on this topic

Patient education: Checking your child's blood sugar level (The Basics)
Patient education: Managing blood sugar in children with diabetes (The Basics)
Patient education: Blood glucose tests (The Basics)
Patient education: Type 1 diabetes in children (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: The ABCs of diabetes (The Basics)
Patient education: Using insulin (The Basics)
Patient education: Managing diabetes in school (The Basics)
Patient education: Sick day planning for people with type 1 diabetes (The Basics)

Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics)
Patient education: Glucose monitoring in diabetes (Beyond the Basics)
Patient education: Type 1 diabetes: Overview (Beyond the Basics)
Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: Type 2 diabetes: Insulin treatment (Beyond the Basics)