Introduction

Low blood sugar, also called hypoglycemia, occurs when the sugar (glucose) level in the blood of a person with diabetes drops below what the body needs to function normally. Taking too much insulin, not eating enough food or skipping meals, or exercising more than usual can cause blood sugar levels to drop rapidly.

If your child's blood sugar level drops very low and he or she does not get help, your child could have a seizure or go into a coma and possibly die.

These four simple steps might save your child's life:

• Test your child's blood sugar as suggested by his or her doctor so that you do not have to guess when your child's blood sugar is low.
• Be alert to the early signs of low blood sugar: sweating, shakiness, hunger, blurred vision, and dizziness.
• Have your child keep some hard candy, raisins, or other foods that contain sugar with him or her at all times. Your child should eat some at the first sign of low blood sugar.
• Teach all of your child's caregivers what to do if your child's blood sugar is very low.

 What is low blood sugar?
 Why is low blood sugar a problem?
 How do you deal with low blood sugar?
 Where to go from here

More information about children and diabetes can be found in these topics:

• Type 1 Diabetes: Recently Diagnosed
• Type 1 Diabetes: Children Living With the Disease
• Type 2 Diabetes in Children

Return to topic:

What is low blood sugar?

Low blood sugar means that the level of sugar (glucose) in your child's blood has dropped below what his or her body needs to function normally. When your child's blood sugar level drops below 70 milligrams per deciliter (mg/dL), he or she most likely will have symptoms, such as feeling tired, weak, or shaky. Very low blood sugar levels (below 20 mg/dL) can develop quickly and are emergency situations that require immediate care. You can give your child a glucagon shot to bring his or her blood sugar back up. Follow the instructions that come with the glucagon kit. Without immediate care, a very low blood sugar level can lead to coma and death.

Sometimes people with diabetes develop low blood sugar levels during the night. If your child's level drops during the night, he or she may wake up in a cold sweat and feel weak. But some children sleep through it because the body uses stored sugar to raise their blood sugar level back to their target range. If this happens, your child may wake up in the morning with only a headache and possibly high blood sugar.

What causes low blood sugar?

Very low blood sugar can develop rapidly (within minutes). It can occur if your child:

• Takes too much insulin.
• Skips or delays a meal or snack.
• Exercises too much without eating enough food.

Children may have symptoms of low blood sugar if their blood sugar drops to a lower level than usual. For example, if your child's level has been in the 300s for a week and it drops suddenly to 100, he or she may have symptoms of low blood sugar. Even though 100 is in the normal range, it is much lower than your child is used to. It is also possible that after having diabetes for many years, your child may not have symptoms of low blood sugar until the level is very low. When the blood sugar level is very low, your child may be too confused to remember how to treat low blood sugar.

Test Your Knowledge

1. Low blood sugar means that the level of sugar in the blood has dropped below what the body needs to function normally (usually below 70 mg/dL).
1. True
   

   The answer is correct

   Low blood sugar means that the level of sugar in the blood has dropped below what the body needs to function normally, usually below 70 mg/dL. When your child's blood sugar level drops below 70 mg/dL, he or she most likely will have symptoms, such as feeling tired, weak, or shaky.

   
2. False
   

   The answer is incorrect

   Low blood sugar means that the level of sugar in the blood has dropped below what the body needs to function normally, usually below 70 mg/dL. When your child's blood sugar level drops below 70 mg/dL, he or she most likely will have symptoms, such as feeling tired, weak, or shaky.

   
2. Very low blood sugar levels (below 20 mg/dL) are emergency situations and require immediate care, such as giving your child a glucagon shot.
1. True
   

   The answer is correct

   Very low blood sugar levels (below 20 mg/dL) are emergencies, and your child needs care immediately. You can give your child a glucagon shot to bring his or her blood sugar back up. Follow the instructions that come with the glucagon kit. If your child does not receive immediate care, a very low blood sugar level could lead to coma and death.

   
2. False
   

   The answer is incorrect

   Very low blood sugar levels (below 20 mg/dL) are emergencies, and your child needs care immediately. You can give your child a glucagon shot to bring his or her blood sugar back up. Follow the instructions that come with the glucagon kit. If your child does not receive immediate care, a very low blood sugar level could lead to coma and death.

   

Continue to Why is low blood sugar a problem?
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Why is low blood sugar a problem?

When children's blood sugar levels fall below 70 mg/dL, their bodies react the same as when they are very afraid, angry, or anxious. These symptoms of mild low blood sugar often last for only a short time if your child eats food containing sugar. An emergency situation will not likely develop, and your child won't have any lasting effects.

If your child's blood sugar continues to drop (below 40 mg/dL), the brain may receive too little sugar to work properly, and judgment and muscle coordination are affected. Children may not realize that their blood sugar is too low and may not think they need to eat food to raise the level. You or someone else may have to help your child eat or drink something.

If your child's blood sugar level continues to drop (below 20 mg/dL), he or she can have a seizure or lose consciousness. If your child doesn't receive prompt emergency care, such as a glucagon shot, he or she may go into a coma and possibly die.

Test Your Knowledge

1. If your child's blood sugar level drops very low (below 20 mg/dL):
1. He or she could fall into a coma and possibly die.
   

   The answer is correct

   Blood sugar levels in children who take insulin can drop very rapidly (within minutes). If your child's blood sugar level drops to 20 mg/dL or lower, he or she could fall into a coma and possibly die. A glucagon shot will be necessary. Prompt emergency care is needed.

   
2. He or she will seem normal.
   

   The answer is incorrect

   Blood sugar levels in children who take insulin can drop very rapidly (within minutes). If your child's blood sugar level drops to 20 mg/dL or lower, he or she will not seem normal. A glucagon shot will be necessary. The correct answer is a. If your child's blood sugar level drops to 20 mg/dL or lower, he or she could fall into a coma and possibly die. A glucagon shot will be necessary. Prompt emergency care is needed.

   
3. He or she will be able to eat or drink something to raise it.
   

   The answer is incorrect

   Blood sugar levels in children who take insulin can drop very rapidly (within minutes). If your child's blood sugar level drops to 20 mg/dL or lower, he or she will not be able to eat or drink something to raise it. A glucagon shot will be necessary. The correct answer is a. If your child's blood sugar level drops to 20 mg/dL or lower, he or she could fall into a coma and possibly die. A glucagon shot will be necessary. Prompt emergency care is needed.

   
4. He or she can still function if needed.
   

   The answer is incorrect

   Blood sugar levels in children who take insulin can drop very rapidly (within minutes). If your child's blood sugar level drops to 20 mg/dL or lower, he or she will not be able to function if needed. A glucagon shot will be necessary. The correct answer is a. If your child's blood sugar level drops to 20 mg/dL or lower, he or she could fall into a coma and possibly die. A glucagon shot will be necessary. Prompt emergency care is needed.

   

Continue to How do you deal with low blood sugar?
Return to Diabetes in children: Preventing low blood sugar

How do you deal with low blood sugar?

Low blood sugar levels can develop rapidly, within minutes. Treat low blood sugar symptoms as soon as you notice them.

Here are some ways to manage a low blood sugar emergency.

Be prepared

• Keep some quick-sugar food with your child at all times. Quick-sugar food can raise your child's blood sugar level by 30 mg/dL in 15 minutes.
• Know the symptoms of low blood sugar. Post these symptoms where the list can be seen often, and have your child carry a copy at all times. Add any symptoms that your child has that aren't on the list.
• Have your child wear medical identification, such as a medical alert bracelet, in case your child's blood sugar drops very low and he or she needs help. For more information, see the Where to Go From Here section for information on purchasing medical identification.
• Keep glucagon on hand. If your child becomes unconscious when his or her blood sugar is very low, someone may need to give your child an injection of glucagon to raise the blood sugar level. Keep the instructions for how to give glucagon with your child's glucagon. Also, check the expiration date on the glucagon—most glucagon kits need replacing every 6 months.
• Teach your child's caregivers how to check blood sugar. Have instructions for using the blood sugar meter stored with the meter so the caregiver can review the instructions if needed.
• Post the emergency care for low blood sugar instructions in a convenient place at home and at school.

Treat low blood sugar early

Check your child's blood sugar level if you think it may be low, even if you don't see any symptoms. If your child's blood sugar level is below 70 mg/dL:

• If your child is alert, give him or her some quick-sugar food. Liquids raise your child's blood sugar faster than solid foods.
  • Check your child's blood sugar level after 15 minutes. It will take about 15 minutes for the sugar in the food to get into your child's bloodstream.
  • Wait another 15 minutes and check your child's blood sugar level again. If his or her blood sugar is still below 70 mg/dL, have your child eat or drink something that contains sugar and protein, such as milk.
• If your child is not alert, follow the appropriate guidelines:
  • If your child does not take insulin injections, see emergency care for a child with low blood sugar who does not take insulin.
  • If your child takes insulin, see emergency care for a child with low blood sugar who takes insulin.
  • If your child uses an insulin pump, stop it or put it in "suspend" mode as previously instructed. If this is not possible, disconnect the pump from the catheter at the injection site.

After the episode

• When your child's blood sugar has returned to above 70 mg/dL, feed him or her a regular meal or a snack with protein, such as a turkey or ham sandwich. This will help keep his or her blood sugar from dropping again.
• Write down your child's symptoms and what you did. Use the low blood sugar level record(What is a PDF document?) .
• Let the doctor know if your child is having frequent low blood sugar problems. His or her medicine or insulin pump may need to be changed or adjusted.

Test Your Knowledge

1. In preparation for a low blood sugar emergency, my child needs to carry:
1. His or her insulin.
   

   The answer is incorrect

   To be prepared for a low blood sugar emergency, your child does not need to carry insulin. Taking insulin will make your child's blood sugar droplower. The correct answer is b. To be prepared for a low blood sugar emergency, always have your child carry some quick-sugar foods with him or her. Review the list of quick-sugar foods.

   
2. Some quick-sugar foods.
   

   The answer is correct

   To be prepared for a low blood sugar emergency, your child needs to carry some quick-sugar foods with him or her at all times. Review the list of quick-sugar foods.

   
3. A note from my child's doctor.
   

   The answer is incorrect

   To be prepared for a low blood sugar emergency, your child does not need to carry a note from his or her doctor. The correct answer is b. To be prepared for a low blood sugar emergency, always have your child carry some quick-sugar foods with him or her. Review the list of quick-sugar foods.

   
2. To prevent a low blood sugar emergency, your child needs to treat symptoms of low blood sugar as soon as they are noticed. To treat low blood sugar before it becomes an emergency, your child needs to:
1. Take an extra dose of insulin.
   

   The answer is incorrect

   To treat low blood sugar before it becomes an emergency, your child does not need to take an extra dose of insulin. Taking insulin will make your child's blood sugar drop lower. The correct answer is c. Avoid low blood sugar emergencies by treating symptoms as soon as they are noticed. Your child needs to eat some food that contains sugar to raise his or her blood sugar level and prevent an emergency.

   
2. Go to sleep and rest.
   

   The answer is incorrect

   To treat low blood sugar before it becomes an emergency, your child should not go to sleep and rest. Your child's blood sugar level may continue to drop, leading to an emergency situation. The correct answer is c. Avoid low blood sugar emergencies by treating symptoms as soon as they are noticed. Your child needs to eat some food that contains sugar to raise his or her blood sugar level and prevent an emergency.

   
3. Eat some food that contains sugar.
   

   The answer is correct

   To treat low blood sugar before it becomes an emergency, your child needs to eat some food that contains sugar. Food that contains sugar will raise your child's blood sugar level and prevent an emergency.

   

Continue to Where to go from here
Return to Diabetes in children: Preventing low blood sugar

Where to go from here

Talk with your child's doctor

If you have questions about this information, take it with you and discuss it with the doctor. You may want to mark areas or make notes in the margins of the pages where you have questions.

If you don't already have glucagon at home, ask your child's doctor for a prescription. Make sure your child's caregivers know how to give a glucagon shot if an emergency develops.

If you would like more information on dealing with low blood sugar levels, the following resources are available:

Online Resource

Organization

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