Diabetes family education. Low blood sugar (hypoglycemia)
by the diabetes education program at The Hospital for Sick Children.
This resource looks at what hypoglycemia is and how to prevent and treat it.
Understanding hypoglycemia. Understanding the signs and symptoms of hypoglycemia or low blood sugar
levels, and how to treat low blood sugar level events, is an important part of diabetes management.
We will cover these topics in this resource. Low blood sugar or hypoglycemia. For people who do
not have diabetes, the body knows when and how to turn off insulin production when blood sugar
levels go down. But for people with diabetes, it is not possible to stop insulin that has been
given by injection. The insulin will continue to work and do its job until the dose is finished.
If the injected insulin brings the blood sugar levels below target, this can cause hypoglycemia.
Note: This is the opposite of hyperglycemia which occurs when blood sugar levels are above target.
What is hypoglycemia? The blood sugar balancing act is like a teeter-totter with levels going up
or down depending on predictable factors. There will be times when the teeter totter tips and
the blood sugar level drops. Hypoglycemia is the term used when the blood sugar level is below
4.0 millimole per liter. Why does hypoglycemia happen? What causes this imbalance?
Not enough food, because of a missed snack, a late meal or not enough carbohydrates being eaten.
Too much physical activity because: the activity goes longer than usual or is of greater intensity,
or too much insulin because of an error in the type of insulin given,
an error in the amount of insulin given or the dose of insulin needs to be lowered.
Hypoglycemia can occur both during the day or night. It may happen quickly and will often
occur when the insulin is working the hardest (at its peak of action). For fast-acting insulin
this is usually one to two hours after it is injected.
How do you recognize hypoglycemia? The early warning signs of hypoglycemia
are just like those feelings you may have if you missed a meal.
The body is sending a signal that the blood sugar is low. These signals may vary from child to child.
The signs of mild and moderate hypoglycemia include: feeling tired, increased hunger,
shakiness, a fast heartbeat, blurred vision, mood changes, cold clammy skin, sweatiness,
paleness, headaches, poor concentration and lack of energy.
These are additional low symptoms that can appear during sleep: restless sleep, crying
out and nightmares, or waking with a headache. How is hypoglycemia managed? If your child is
experiencing any of the symptoms of low blood sugar levels, follow these four steps right away.
check, treat, wait and recheck. Let's look at each of these. One. Check. Use a glucose meter to
confirm the low blood sugar level. If using a sensor, please talk to your diabetes team.
Two. Treat. Use a source of fast-acting sugar to treat the low blood sugar level.
Fast acting sugar is instantly digested and quickly raises the blood sugar level.
Depending upon your child's weight, 5 to 15 grams of carbohydrates is needed.
Some examples of fast-acting sugars are fruit juice, milk, regular pop, dex four tabs and skittles.
These sources may not be the best treatment choice: chocolate or candy bars, granola bars, cookies, ice
cream, yogurt or pieces of fruit. These foods will not raise the blood sugar levels fast enough.
How much of a fast-acting sugar to treat with is determined by the weight of the child.
Use this chart as a guideline for the amount of carbohydrate needed
to treat low blood sugar levels. Five, 10 or 15 grams, depending on your child's weight.
Three. After treatment wait 15 minutes: This is the time needed to raise the blood sugar level.
Then four: Recheck. After 15 minutes, use the glucose meter to recheck the blood sugar level
to make sure it has increased to 4.0 millimole per liter or more. If the blood sugar level is
still low, retreat with a fast-acting sugar and recheck the blood sugar in 15 minutes.
After treatment, provide a carbohydrate snack that includes a protein if: the next meal is
more than one hour away, if the low occurs during the middle of the night, or if the low occurs
during an activity. This type of snack will help to prevent the blood sugar level from going low again.
For example, crackers and cheese, yogurt and fruit, or bread and peanut butter.
Low blood sugar check-in. Since diagnosis, has your child experienced a low blood sugar level? When did
it happen? What signs did they show, if any? What did you do to treat it? What do you think the cause was?
How do we prevent hypoglycemia? The best way to prevent a low blood sugar level
from happening again is to reflect on why it may have occurred. Ask yourself:
Was there too little food? Was there more physical activity than usual? Was there too much insulin?
Here are some tips for reducing the frequency of low blood sugar level events. Eat meals and snacks
at regular intervals. Ensure the proper insulin and dose are given, and plan for extra activities
by eating additional carbohydrates or decreasing the fast-acting insulin dose prior to the activity.
Key reminders. Always carry a fast-acting sugar and extra carbohydrate snack with you.
Always have a blood glucose meter with you and contact your diabetes nurse if your
child is experiencing frequent low blood sugar levels or a pattern of low blood sugar levels.
Test your knowledge with this common situation where the balance may be tipped
and low blood sugar (hypoglycemia) may occur.
Your child is eight years old and is playing in the park with their younger sister.
Your child has stopped playing and is tired and does not want to play anymore.
They ask you for something to eat. What are some of the signs that your child is showing
that their blood sugar level is likely low? A - their activity stopped. B - they are feeling tired.
C - they are feeling hungry or D all of the above. The answer is D, all of the above are
signs of hypoglycemia or low blood sugar level. As your child experiences a low blood sugar level,
you will become aware of the signs that may be specific to your child. Now, what is the first
thing that you should do? A - pack up your child and their sister and walk back home to get a snack.
B - check your child's blood sugar level with the meter they have in their backpack.
C - give your child a snack of crackers and cheese they have brought to the park.
Or D - give your child a drink of juice. The correct answer is B, check your child's blood sugar level
with the glucose meter they have in their backpack. It is necessary to always carry the equipment,
such as a lancing device or finger poker and meter, to check blood sugar levels at times
outside of the regular meal times. A low blood sugar level reading can be confirmed
and then a fast-acting sugar, such as juice, can be given to treat the low blood sugar level.
You gave your child a 15 gram juice box to treat their low blood sugar of 3.6 millimole per liter.
What should you do next? A - return home to make lunch for your child.
B - give more juice if your child is wanting more to drink. C - wait 15 minutes and recheck
your child's blood sugar level or D give your child a snack as they are hungry.
The answer is C. Wait 15 minutes and recheck their blood sugar. It is important to recheck
your child's blood sugar to know if it has returned to above 4.0 millimole per liter.
If the blood sugar is still less than 4.0 millimole per liter after 15 minutes, then your
child will need another 15 grams of juice. If your child's blood sugar is now 5.1 millimole per liter
and it is more than an hour before they have their lunch, then they can have a snack such as crackers
and cheese which can help to prevent another low blood sugar level soon afterwards. Remember. Finding
blood sugar balance needs planning and awareness of the predictable and unpredictable factors.
Look for the signs and symptoms of low blood sugar levels and think about why they happened. And be
prepared to treat mild or moderate low blood sugar level events by having supplies with you.
We are here to help. If you have questions or need further tips, please contact your diabetes team.