Tamariki (children) and rangatahi (young people) need urgent treatment for hypoglycaemia.
Hypoglycaemia happens when the blood glucose level is low enough to cause signs or symptoms, including impaired brain functioning. These can expose your child to possible harm.
The level used to identify and treat hypoglycaemia in your child with diabetes is less than 4.0 mmol/L.
See a short video about hypoglycaemia at the Starship Child Health website [1].
Symptoms of mild to moderate hypoglycaemia may include one or more of the following:
Babies and young children may not say that they are feeling unwell.
In younger children, change in behaviour is the most common sign. They may be unusually quiet, grizzly, unhappy or hungry. If you notice any of these symptoms in your child, or if you are concerned about your child's behaviour for any reason, it is important to check their glucose levels.
If using intermittently scanned continuous glucose monitoring, for example Freestyle Libre-1, it is important to check your child's blood glucose level with a finger-prick. This will confirm either:
You might find a hypoglycaemia flow chart (PDF, 80KB) [2] helpful for what to do if your child has hypoglycaemia.
Treatment is urgent.
The amount of glucose needed to treat hypoglycaemia depends on your child's size, insulin plan, recent insulin dose and recent exercise.
If there are any signs or symptoms of hypoglycaemia, confirm hypoglycaemia by checking glucose level.
You may detect hypoglycaemia (less than 4 mmol/L) during a routine glucose level check.
It is important to do a finger prick check if:
Amount of glucose to give:
Examples of using the formula (0.3g/kg of your child's current weight):
Examples of glucose include:
Juice drink
Glucose tablets
Other options
Re-check blood glucose level after 10 to 15 minutes.
Symptoms should go away within 10 to 15 minutes of step 1 treatment.
If blood glucose level is less than 4 mmol/L at the 10 to 15 minute check, repeat step 1 treatment.
If blood glucose level is greater than 4 mmol/L, move to step 3.
Snack examples include (adjust for the age and size of your child):
Your child will not always need a follow-up carbohydrate snack - see note for children on insulin pump therapy.
Children on insulin pump therapy will often NOT need the follow up or long-acting carbohydrate, unless their glucose level is less than 3 mmol/L.
Often, children on pumps also need less carbohydrates than those on injections to treat hypoglycaemia. This is especially true for children on either:
If the system is suspending insulin delivery because it is predicting a low glucose level, do NOT treat with carbs. Only treat glucose levels confirmed less than 4 mmol/L.
If your child is on HCL, they will likely NOT need a snack to prevent lows when exercising.
Hypoglycaemia at night is more likely to happen after increased levels of activity during the day or if your child has eaten less or is unwell. It is important to talk with your child's paediatric diabetes team for individual advice for your child.
Some strategies to reduce the risk of hypoglycaemia at night are:
Hypoglycaemia unawareness (also called impaired awareness of hypoglycaemia) is when a blood glucose check shows hypoglycaemia but your child is not aware of it.
Toddlers and young children who are newly diagnosed may not sense hypoglycaemia very effectively. Or, they may not be able to explain how they are feeling. Detecting hypoglycaemia in these particular groups relies solely on others. Children need support to learn how to recognise and describe their hypoglycaemia symptoms.
In older children and teens, hypoglycaemia unawareness can develop following frequent hypoglycaemia episodes. This is a dangerous condition where hypoglycaemia can happen quickly and the risk of severe hypoglycaemia is increased.
Severe hypoglycaemia is when a person is so confused or drowsy they are unable to manage low glucose levels themselves or are unconscious and will need the help of another person.
The symptoms of severe hypoglycaemia include the following:
Someone with severe hypoglycaemia may also:
Do NOT give your child food or drink if they are unable to swallow as this might lead to choking.
The symptoms of severe hypoglycaemia are a blood glucose level less than 4 mmol/L and extreme drowsiness and disorientation or confusion. Someone with severe hypoglycaemia may also:
In severe hypoglycaemia, you or someone else needs to make a judgement about whether it is safe to treat your child with sweet foods or drink. Your child needs to be conscious and cooperative enough to be able to swallow. If your child is too drowsy or disoriented to understand and follow instructions, then they shouldn't have anything by mouth. This is to prevent possible choking.
The GlucaGen™ hypokit contains a synthetic form of glucagon. Only parents and others who have been appropriately trained can give a glucagon injection.
Find out when to use mini-dose glucagon for children with diabetes [4].
Symptoms of hypoglycaemia can be distressing for children and young people, and parents. This can lead to a significant fear or avoidance of hypoglycaemia. This fear can increase anxiety, cause interrupted or poor sleep patterns and reduce a person's quality of life (both children and parents).
Fear of hypoglycaemia can also lead to people preferring higher glucose levels which comes with other risks and will NOT necessarily prevent hypoglycaemia. Talk to your diabetes team so that you and your child can be supported.
Find out about possible complications in children with diabetes [5].
The content on this page has been approved by the Clinical Network for Children and Young People with Diabetes, Paediatric Society of New Zealand.
This page last reviewed 15 February 2023.
Email us [7] your feedback
Links
[1] https://www.starship.org.nz/patients-parents-and-visitors/health-information-and-education-resources/diabetes-teaching-resources-for-children-young-people-and-their-families/what-you-need-to-know-about-hypoglycaemia/
[2] https://www.kidshealth.org.nz/sites/kidshealth/files/pdfs/Hypoglycaemia%20Flowchart%20-%20Kidshealth.pdf
[3] https://vimeo.com/166128429
[4] https://www.kidshealth.org.nz/when-use-mini-dose-glucagon-children-diabetes
[5] https://www.kidshealth.org.nz/possible-complications-children-diabetes
[6] https://www.kidshealth.org.nz/tags/diabetes
[7] https://www.kidshealth.org.nz/contact?from=http%3A%2F%2Fwww.kidshealth.org.nz%2Fprint%2F1925%3Flanguage%3Dmi