Children's Health and Wellness

Hypoglycemia in Children

What is hypoglycemia?

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 blood differs based on the most recent meal. Babies and small children with type 1 diabetes will have different goal ranges of blood glucose levels. 

What causes hypoglycemia?

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
  • Conditions that cause too much insulin in the body (hyperinsulinism)
  • Tumor on the pancreas that makes insulin (insulinoma)
  • Taking diabetes medicine called sulfonylurea
  • Congenital problems with metabolism
  • 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

Who is at risk for hypoglycemia?

The biggest risk factor is having type 1 diabetes.

What are the symptoms of hypoglycemia?

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
  • Clumsy or jerky movements
  • Trouble paying attention
  • Confusion
  • Tingling feelings around the mouth
  • Seizure

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

How is hypoglycemia diagnosed?

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.

How is hypoglycemia treated?

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.

What are possible complications of hypoglycemia?

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.

Can hypoglycemia be prevented?

Not all episodes of hypoglycemia can be prevented. Most children with type 1 diabetes will have hypoglycemia. But you can help prevent severe episodes by:

  • Testing your child’s blood glucose often
  • 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 snack if needed

Living with hypoglycemia

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.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if your child:

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

Key points about hypoglycemia

  • 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.
  • 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 health care provider:
  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • 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.
Print Source: Americn Diabetes Association. Standards of medical Care in Diabetes. Diabetes Care (2013); 36(1); pp. s1-s66
Print Source: Up to Date: Associated Autoimmune Diseases in Children and Adolescents with Type 1 Diabetes Mellitus
Print Source: Up to Date: Hypoglycemia in Adults: Clinical Manifestations, Definition, and Causes
Print Source: Up to Date: Management of Type 1 Diabetes Mellitus in Children and Adolescents
Online Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.aspx
Online Source: Natinal Diabetes Education Programhttp://ndep.nih.gov/media/numatglance_eng-508.pdf
Online Source: American Diabetes Associationhttp://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html
Online Source: American Academy of Pediatricshttp://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Causes-of-High-Blood-Glucose-and-Low-Blood-Glucose.aspx
Online Editor: Sims, Jane
Online Medical Reviewer: Bass, Pat F. III, MD, MPH
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Date Last Reviewed: 7/18/2015
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