What is hypoglycemia?

When a child has diabetes, the amount of sugar, or glucose, their blood can fall too low. A low blood sugar level is called hypoglycemia. Blood sugar levels can fall very quickly.

Generally, when your child’s blood sugar level is less than 70 mg/dL, they have hypoglycemia. However, your child’s doctor or nurse might give you a specific blood sugar measure at which your child should be treated for hypoglycemia. The blood sugar level given varies for different people with Type 1 diabetes. It depends on whether you have just been diagnosed with diabetes or whether you have had it for a long time. It can also depend on your age or on the time of day.

When your child has hypoglycemia, they will need treatment right away.

What causes hypoglycemia?

There are a few causes of hypoglycemia, including:

  • Physical activity or exercise
  • This is the most common cause of hypoglycemia. Your child can develop hypoglycemia soon after exercising or from 4-12 hours after exercise. Sometimes it can happen up to 24 hours (delayed hypoglycemia)
  • Missed meal or snack (When your child does not eat the amount of food they planned to eat)
  • Miscounting carbohydrates in foods
  • Making a mistake in drawing up or administering insulin (insulin dose is too high)
  • If your child is sick, vomiting or has diarrhea

How can I help keep my child's blood sugar levels normal?

Hypoglycemia happens to everyone with Type 1 diabetes at some point in their lives. It is a normal part of having Type 1 diabetes, even though it can make you nervous at times. Severe hypoglycemia is rare, but serious. Your child will need treatment right away if they develop hypoglycemia.

Here are some ways you can help keep your child’s blood sugar levels within a normal range while eating:

  • If your child doesn’t finish a meal, give them different forms of carbohydrate, like milk.
  • If your child doesn’t finish meals often, you might need to think about giving some or all of your child’s insulin after they done eating. Talk about this with your child’s treatment team. If you’re counting carbohydrates for the first time and you’re not sure about the ingredients in a meal, try to underestimate the number of carbohydrates in that meal. This is helpful when you’re eating out at a restaurant and the nutrition information isn’t always available.

Here are some tips on how to keep your child’s blood sugar levels within a normal range while exercising:

  • As a general rule, you should check your child’s blood sugar levels before they exercise. If your child’s blood sugar level is lower than 150 mg/dL, your child should eat a small snack (15g of carbohydrates) for each hour of planned activity before exercising.
  • To help prevent hypoglycemia related to exercise, talk with your child’s doctor or nurse to adjust insulin dose before and after exercise.
  • If your child has an insulin pump, they could disconnect from the pump and set a temporary basal rate before, during or after exercise. This depends on when your child is more likely to develop hypoglycemia.

What are the signs of and treatment for hypoglycemia?

Some children might have symptoms of hypoglycemia while others will not feel anything different. You might realize your child has hypoglycemia when you do regular blood sugar tests and find that his or her blood sugar level is low.

There are 3 levels of hypoglycemia: mild, moderate and severe. Young children might not show these symptoms. Sometimes, they just might not seem like themselves. Here are the symptoms your child might have at each level and how you can help your child, depending on their age:

Symptoms of mild hypoglycemia (60-80 mg/dL)

Your child might have some of the common symptoms of mild hypoglycemia, such as:

  • Shaking or sweating
  • Crankiness, irritability or anxiety
  • Tiredness, weakness or paleness
  • Hunger
  • Headache
  • Confusion

Symptoms of moderate hypoglycemia (50-60 mg/dL)

With moderate hypoglycemia, your child might have symptoms of mild hypoglycemia AND might:

  • Be confused or disoriented
  • Need help eating and drinking

Symptoms of severe hypoglycemia (40-50 mg/dL and under)

Severe hypoglycemia is rare, but is very serious. Your child needs treatment right away if they have these symptoms of severe hypoglycemia:

  • Passing out (fainting)
  • Losing consciousness
  • Having a seizure

Treatment for mild or moderate hypoglycemia

It’s important to give your child sugar that can be absorbed quickly. Give your child one of these sugars, then wait 15 minutes. Retest your child’s blood sugar level. If it’s still under 70 mg/dL, give your child more of these sugars.

Small child under age 5 (5-10 grams of carbohydrates)

  • ¼ - ½ cup of juice
  • 2 teaspoons of cake gel icing
  • ¾ cup of milk

Older child age 5-10 (10-15 grams of carbohydrates)

  • ½ cup of juice
  • 4-5 ounces of regular soda
  • 2-3 glucose tablets
  • 10-15 Skittles® candies

Teenager over age 10 (15 grams of carbohydrates)

  • ½ - ¾ cup of juice
  • 5-6 ounces of regular soda
  • 3-4 glucose tablets
  • 15 Skittles® candies

Treatment for severe hypoglycemia

You will need to give your child an injection of glucagon. Then, wait 10-15 minutes. Glucagon will help raise your child’s blood sugar level back to normal. The amount depends on your child’s age. Do not worry about giving too much. It isn’t possible to give too much glucagon.

Small child under age 5

0.3 mg

Teenager over age 10

1 mg

Older child age 5-age 10

0.5 mg

Rev. 9/2016. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.