Hypoglycemia is a condition characterized by low blood sugar, or abnormally low levels of glucose in the blood.
Hypoglycemia (also known as a hypo, insulin shock, and a low) is brought on by abnormally low levels of glucose in the blood (i.e., 70 mg/dl or less). The condition is common among children with type 1 diabetes, but may also occur less frequently in children or teens with type 2 diabetes who are taking a sulfonylurea drug. An inadequate diet, improperly calculated insulin dose, minor illnesses, or excessive activity without adequate sustenance can contribute to the condition. If unchecked, hypoglycemia can lead to unconsciousness. In very rare cases, the victim may suffer a seizure.
A hypoglycemic child will appear irritable, sweaty, shaky, and confused and may complain of being very hungry. In most cases, a snack of quick-acting carbohydrates (e.g., juice or hard candy) will remedy the situation. Glucose tablets or gel can also be taken. A child who has lost consciousness due to hypoglycemia may require a glucagon shot to return blood sugar levels to normal.
Newborns of women with gestational, type 1, or type 2 diabetes during pregnancy may also experience hypoglycemia at birth, particularly if the mother's blood glucose levels were not well controlled in late pregnancy. High levels of maternal glucose cause the fetus to generate equally high levels of insulin to handle the over-load, and when the maternal glucose source is disconnected at birth with the cutting of the umbilical cord, all of that insulin causes the newborn's blood sugar levels to plummet. Intravenous administration of a glucose solution to the newborn can help re-establish normal blood sugar levels.
A rare type of hypoglycemia, known as reactive hypoglycemia, may occur in children and teens without diabetes. In reactive hypoglycemia, blood glucose levels drop to 70 mg/dl approximately four hours after a meal is eaten, causing the same symptoms of low blood sugars that can occur in people with diabetes.
Also rare is fasting hypoglycemia, a condition in which blood sugars are 50 mg/dl or lower after an over-night fast or between meals. Certain medications and medical conditions can cause this problem in children who do not have diabetes.
Among children with diabetes, hypoglycemia is much more common in those with type 1 diabetes (also known as insulin-dependent diabetes or juvenile diabetes) than in those with type 2 diabetes (formerly known as adult-onset diabetes).
Causes and symptoms
Hypoglycemia in children and teens with diabetes can be triggered by too much insulin, excessive exercise without proper food intake, certain oral medications, skipping meals, and drinking alcoholic beverages.
Symptoms of hypoglycemia include:
- feelings of anxiety
Reactive hypoglycemia can be triggered by enzyme disorders and by gastric bypass surgery. Causes of fasting hypoglycemia in children without diabetes may include insulin-producing tumors, certain hormonal deficiencies, medications (including sulfa drugs and large doses of aspirin), and critical illnesses. Fasting hypoglycemia is more likely to occur in children under the age of 10.
When to call the doctor
Children who are experiencing frequent episodes of hypoglycemia should see their diabetes care doctor as soon as possible as they may require an insulin adjustment, medication change, or another change in their treatment regimen.
If a child or teen with diabetes starts experiencing low blood sugars without any symptoms, he or she may be developing hypoglycemic unawareness and the child's physician should be notified immediately. In hypoglycemic unawareness, the body stops sending its normal warning signs of hypoglycemia, and a child may not realize that blood glucose levels are dangerously low until he or she loses consciousness.
Episodes of hypoglycemia in children and adolescents with diabetes can be confirmed with a blood test on a home blood glucose monitor. A small needle or lancet is used to prick the finger or an alternate site and a small drop of blood is collected on a test strip that is inserted into the monitor. The monitor then calculates and displays the blood glucose reading on a screen. Although individual blood glucose targets should be determined by a medical professional in light of a child's medical history, the general goal is to keep them as close to normal (i.e., 90 to 130 mg/dl or 5 to 7.2 mmol/L before meals) as possible. Glucose levels that are below 70 mg/dl (3.9 mmol/L) are typically considered hypoglycemic.
In order to diagnose reactive hypoglycemia in those without diabetes, a blood sample must be drawn while a child is experiencing symptoms. If the blood glucose levels are 70 mg/dl or lower and the symptoms subside after food or drink is provided, reactive hypoglycemia is diagnosed.
Children with diabetes who exhibit symptoms of hypoglycemia should check their blood glucose levels on a home glucose meter immediately. If levels are 70 mg/dl (3.9 mmol/L) or lower, they should take 15 grams of a fast-acting carbohydrate (e.g., glucose tablets, Life Savers, regular cola), wait 15 minutes, and test their blood sugars again. If levels are still too low, repeating the procedure is necessary until blood glucose is within a safe range.
Giving an unconscious child or teen food or drink by mouth can be potentially dangerous due to the possibility of choking . A glucagon injection should be used on a child that has lost consciousness due to hypoglycemia. Glucagon is a hormone manufactured by the pancreas that triggers the release of blood glucose by the liver. The synthetic version of the hormone is used to rapidly raise blood glucose levels in people with diabetes experiencing a severe low. A glucagon injection kit contains a syringe of sterile water and a vial of powdered glucagon. The water is injected into the glucagon vial and then mixed, and the resulting solution is drawn back into the syringe for injection into any muscular area (e.g., arm, buttock, thigh). Glucagon can cause vomiting , so a child that is given a glucagons injection should be monitored carefully to prevent aspiration.
Episodes of reactive and fasting hypoglycemia in children without diabetes can also be treated with a fast-acting carbohydrate.
For children with diabetes, eating or drinking large quantities of carbohydrates in an attempt to push blood glucose levels back to normal can result in hyperglycemia , or blood sugars that are too high. The 15 grams/15 minutes rule is important to follow to avoid dramatic blood sugar swings.
Eating small, frequent meals and spreading carbohydrate intake throughout the day may help keep blood glucose levels from bouncing too high or too low.
With early detection and immediate and appropriate treatment, children will recover quickly from hypoglycemia.
The best way to prevent hypoglycemia is to check blood glucose levels frequently and treat falling blood sugars before they become dangerously low. However, even the most dedicated child or parent may be faced with situations that trigger lows, such as a delay in restaurant service after an insulin injection has been taken or a broken hotel elevator that requires one to climb 20 flights of stairs after a vigorous workout in the pool. Because hypoglycemia can be predictable, children with diabetes and their parents should always have a source of fast-acting carbohydrate on hand for treatment.
A child diagnosed with reactive hypoglycemia can alleviate the problem by consuming small, frequent meals (about every three hours) that are heavy in high-fiber, low-sugar foods. Some physicians may also recommend a high-protein, low-carbohydrate diet.
Parents of children with diabetes must work with their child's teachers and school administrators to ensure that their child is able to test his or her blood sugars regularly, take insulin as needed, and have access to food or drink to treat hypoglycemia when necessary. Someone at school should also be trained in how to administer a glucagon injection, an emergency treatment for a hypoglycemic episode when a child loses consciousness. Care-givers of children with type 1 diabetes should have access to an emergency glucagon kit and be trained in its use. This should include a responsible adult at the child's school and at any extracurricular activities where parents are not present.
Section 504 of the Rehabilitation Act of 1973 enables parents to develop both a Section 504 plan (which describes a child's medical needs) and an individualized education plan, or IEP (which describes what special accommodations a child requires to address those needs). An IEP should cover issues surrounding hypoglycemia detection and treatment, and should outline how these episodes should be handled.
Because children who are self-conscious about their differences may not comply with their treatment routines as well as they should when their peers are around, parents should work with schools and caregivers to ensure that their child has a clean and private place to test blood glucose levels and take injections.
Teens who drive and have type 1 diabetes should always test their blood glucose levels before getting behind the wheel, and should have a snack before driving if their levels have fallen below the low range of normal (i.e., 90 mg/dl or 5 mmol/L or lower). Keeping the glove compartment stocked with a roll of glucose tablets can help in the case of an unexpected low on the road.
Fast-acting carbohydrate —A carbohydrate that causes blood sugar levels to rise quickly rather than slowly and steadily. Also called simple sugars. Examples include glucose tablets, honey, fructose, hard candy, and cake frosting.
Glucagon —A hormone produced in the pancreas that changes glycogen, a carbohydrate stored in muscles and the liver, into glucose. It can be used to relax muscles for a procedure such as duodenography. An injectable form of glucagon is sometimes used to treat insulin shock.
Hypoglycemic unawareness —A condition in which normal warning signals of a blood sugar low, such as shakiness, sweating, or rapid heartbeat, are no longer felt.
Reactive hypoglycemia —A rare condition in which blood sugars drop below normal levels approximately four hours after eating.
Sulfonylurea drug —A medication for type 2 diabetes that causes the pancreas to produce more insulin, and may trigger hypoglycemia in some people.
Because alcohol can also trigger hypoglycemia, adolescents should be informed of the risks of drinking. Parents should let their children know that alcohol is both illegal for minors and potentially dangerous to their health, but they should also ensure that teens know what to do to avoid a dangerous low if they do choose to drink. Food should always accompany alcohol, and anyone who drinks in the evening should consider setting an alarm to test blood sugar levels during the night. Many of the symptoms of hypoglycemia can mimic intoxication, so even those teens who do not drink but do attend parties where alcohol is available should always make sure they are with someone whom they can trust who knows what to do in case of hypoglycemia.
See also Diabetes mellitus .
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American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342–2383. Web site: http://www.diabetes.org.
American Dietetic Association. 216 W. Jackson Blvd., Chicago, IL 60606–6995. (312) 899–0040. Web site: http://www.eatright.org.
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Juvenile Diabetes Research Foundation. 120 Wall St., 19th Floor, New York, NY 10005. (800) 533–2873. Web site: http://www.jdrf.org.
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