Overview

Hypoglycemia is when the level of sugar (glucose) in the blood is too low. Glucose is the main source of fuel for the brain and the body. The normal range of blood glucose is about 70 to 140 milligrams per deciliter (mg/dL). The amount differs based on the most recent meal and other things, including medicines taken. Babies and small children with type 1 diabetes will have different goal ranges of blood glucose levels than older children.

Causes

Hypoglycemia can be a condition by itself. Or it can be a complication of diabetes or other disorder. It’s most often a problem in someone with diabetes. It occurs when there’s too much insulin. This is also called an insulin reaction.

Causes in children with diabetes may include:

  • Too much insulin or oral diabetes medicine 
  • The wrong kind of insulin
  • Incorrect blood-glucose readings
  • A missed meal
  • A delayed meal
  • Not enough food eaten for the amount of insulin taken
  • More exercise than usual
  • Diarrhea or vomiting 
  • Injury, illness, infection, or emotional stress 
  • Other health problems, such as celiac disease or an adrenal problem
  • Taking diabetes medicine called sulfonylurea
  • Problems present at birth (congenital) with how the body processes glucose and starches
  • Rare genetic disorders

Hypoglycemia may also occur in these cases:

  • After strenuous exercise
  • During period of time not eating food (fasting)
  • When taking certain medicines
  • After abusing alcohol or salicylates such as aspirin
  • Conditions that cause too much insulin in the body (hyperinsulinism)
  • Tumor on the pancreas that makes insulin (insulinoma)

Risk Factors

The biggest risk factor is having type 1 diabetes.

Symptoms

Symptoms can occur a bit differently in each child. They can include:

  • Shakiness
  • Dizziness
  • Sweating
  • Hunger
  • Headache
  • Irritability
  • Pale skin
  • Sudden moodiness or behavior changes, such as crying for no reason or throwing a tantrum
  • Clumsy or jerky movements
  • Trouble paying attention
  • Confusion
  • Tingling feelings around the mouth
  • Seizure
  • Nightmares and confusion on awakening

The symptoms of hypoglycemia can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Diagnosis

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. Your child may also have blood tests to check blood sugar levels.

When a child with diabetes has symptoms of hypoglycemia, the cause is most often an insulin reaction.

For children with symptoms of hypoglycemia who don’t have diabetes, the healthcare provider may:                                                                                                                     

  • Measure levels of blood sugar and different hormones while the child has symptoms
  • See if symptoms are relieved when the child eats food or sugar
  • Do tests to measure insulin action

Your child may need to do a supervised fasting study in the hospital. This lets healthcare providers test for hypoglycemia safely.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

For children with diabetes, the goal of treatment is to maintain a safe blood glucose level. This is done by:

  • Testing blood glucose often
  • Learning to recognize symptoms
  • Treating the condition quickly

To treat low blood glucose quickly, your child should eat or drink something with sugar such as:

  • Orange juice
  • Milk
  • Cake icing
  • A hard candy

This should be followed by eating food with complex carbohydrates, fat, and protein. A good example is a peanut butter sandwich on whole-grain bread.

Blood glucose levels should be checked every 15 to 20 minutes until they are above 100 dg/dL.

If hypoglycemia is severe, your child may need a glucagon injection. Talk with your child’s healthcare team about this treatment.

Complications

The brain needs blood glucose to function. Not enough glucose can impair the brain's ability to function. Severe or long-lasting hypoglycemia may cause seizures and serious brain injury.

Prevention

Not all episodes of hypoglycemia can be prevented. Most children with type 1 diabetes will have hypoglycemia. The chances of severe hypoglycemia go down as your child gets older. But you can help prevent severe episodes by:

  • Testing your child’s blood glucose often, including at night
  • Checking that the glucose test strips are not outdated and match the glucose meter
  • Recognizing symptoms
  • Treating the condition quickly

Other ways to minimize or prevent hypoglycemia include making sure your child:

  • Takes medicines at the right time
  • Eats enough food
  • Doesn’t skipping meals
  • Checks blood glucose before exercising
  • Eats a healthy snack if needed. The snack should include complex carbohydrates and some fat, if possible.

Living with

Children with type 1 diabetes or other conditions that may cause hypoglycemia need to follow their care plan. It’s important to test blood glucose often, recognize symptoms, and treat the condition quickly. It is also important to take medicines and eat meals on a regular schedule.

Work with your child's healthcare provider to create a plan that fits your child's schedule and activities. Teach your child about diabetes. Encourage them to write down questions they have about diabetes and bring them to healthcare provider appointments. Give them time to ask the provider the questions. Check that the answers are given in a way your child can understand.  Work closely with school nurses, teachers, and psychologists to develop a plan that's right for your child.

When to Call a Healthcare Provider

Call your child’s healthcare provider if your child:

  • Has hypoglycemia often
  • Has moderate to severe episodes of hyperglycemia

Key Points

  • Hypoglycemia occurs when the blood glucose is too low to fuel the brain and the body.
  • It may be a condition by itself, or may be a complication of diabetes or another disorder.
  • To treat low blood glucose right away, your child should eat or drink something with sugar, such as orange juice, milk, cake icing, or a hard candy. They should follow with food with complex carbohydrates, fat, and protein, such as a peanut butter sandwich on whole-grain bread.
  • Severe or long-lasting hypoglycemia may result in seizures and serious brain injury.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.