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Lows

Gas tank showing low blood glucoseLow blood glucose is called “hypoglycemia” or an “insulin reaction”.



Causes
of Low Blood Glucose:

  • a missed or delayed meal or snack
  • not finishing all of the meal or snack
  • extra exercise or activity (not just intense activity – anything that is more than your child’s usual level of activity may increase the amount of glucose taken out of the blood stream and transferred into the cells for energy, thereby lowering blood glucose and possibly causing a low)
  • too much insulin
  • drinking alcohol
  • vomiting from an illness (For more information, see documents in the Illness Management section of this site.)

Note: Knowing the causes of low blood glucose can help prevent them.

Signs and Symptoms of Mild to Moderate Low Blood Glucose:

Signs and symptoms of mild to moderate low blood glucose are:
           *sweating        *dizziness       *clumsiness 
  *trembling    *headache   *confusion
  *hunger   *blurred vision    
  *weakness            *mood changes  
  *paleness   *drowsiness    
 

tips from the trenches of type 1 diabetesI suspect that my son is low when he gets weepy and emotional over things that would usually cause some frustration but would not normally leave him in tears, such as a piece of Lego falling off one of his “creations”. Sometimes his face goes as white as a sheet. Staring into space is another sign that sends us looking for his monitor to check for a low.   

~Michelle


For the Signs and Symptoms of a Severe Low Blood Glucose, see The Basics/Severe Lows.

What to Do in Case of (mild to moderate) Low Blood Glucose:

  • If your child has any of the above symptoms, check her blood glucose.
  • If it is less than 4.0 mmol/L, treat immediately (according to “Treatment Options for Low Blood Glucose” below).
  • Wait 15 minutes and recheck the blood glucose. If it is less than 4.0 mmol/L, repeat treatment.
  • If your child has a low blood glucose just prior to a planned meal or snack: Treat it, wait 15 minutes, re-check, and then give the usual meal/snack.
  • The Canadian Diabetes Association recommends the following: If your child has a low blood glucose and it is more than one hour until the next meal or snack, treat it, wait 15 minutes, then give a snack containing a starch and a protein (for example, crackers and cheese, or ½ of a peanut butter sandwich). This is particularly important for those on an intermediate-acting peaking insulin (N/NPH).

(For advanced strategies following low blood glucose, see Level 3/BG Management)

Treatment Options for Low Blood Glucose

To raise the blood glucose, give rapid-acting carbohydrate. Glucose/dextrose tablets and sucrose (sugar, candy, pop) work the fastest. Fructose (juice or fruit) works more slowly. 

(Note that “dextrose” is the same as “glucose”.)

The Alberta Children’s Hospital Diabetes Clinic recommends:

  • Children under 5 years of age: 10 grams of rapid-acting carbohydrate 

(Michelle says: We have found that 8g carbs has been the ideal low treatment for our just-turned- 5-year-old son in most instances. This has been consistently true for the past 4 years, however we expect that in the not-too-distant future he will require more.)

  • Children 5 years of age and older: 15 grams of rapid-acting carbohydrate

                      Rapid-Acting Carbohydrate Sources (Examples)

 10 grams carbohydrate                (unless otherwise indicated)
 15 grams carbohydrate               (unless otherwise indicated)
  
                        Glucose/Dextrose (works the fastest)                               
     3 Dex4® Glucose Tablets (=12g carbs)       4 Dex4® Glucose Tablets (=16g carbs)     
      1 bottle Dex4® liquid
 
     3 large individual Rockets® (=9g carbs)       5 large individual Rockets®
 
     1 ½ rolls of small Rockets®
      2 rolls of small Rockets®
 
     2/3 cup Gatorade®
      1 cup Gatorade®          
 
      15 g weight of Nerds® Note: Small premeasured boxes are   available at Easter or Halloween. 
   Sucrose
 
     2 tsp. Sugar       3 tsp. Sugar
 
     1/3 cup of regular pop
      1/2 cup of regular pop
 
     2 large marshmallows
      3 large marshmallows
 
     10 Skittles®
      15 Skittles®
 
     5 Jelly Beans®
      7 Jelly Beans®
 
     6 Gummie Bears®
      9 Gummie Bears®
Note: you may want to try President’s Choice® No Name® brand
    1 gummie worm (=8g carbs)
      2 gummie worms (=16g carbs)
Note: you may want to try Squirmies® by Allan® - available at Costco
    6 Gerber’s Graduates Juice Treats®
     10 Gerber’s Graduates Juice Treats®
 
       1 pouch Kool-aid Jammers®
Always check label as this product seems to change often. Currently 17-18g.
   Fructose
 
    ½ cup orange juice
    ¾ cup orange juice
 
   1/3 cup apple juice
    ½ cup apple juice
 
   1 Fruit-to-Go®
     1 ½ Fruit-to-Go®
 

Note: The above carb counts are given as guidelines only – it is advisable to check the carb content of each particular type and brand of fast-acting sugar product that you intend to use as a low treatment.

tips from the trenches of type 1 diabetes


 
To choose the fastest-acting carbs: 

  • For chewy candy, look for a first ingredient of glucose syrup (rather than sugar, which is slower acting, or fructose, which is slowest).
    • For other candies, look for glucose or dextrose as a first ingredient (rather than sucrose).
    • Remember that the glycemic index (GI) value affects how quickly a food or liquid will raise blood glucose; some types of pop are quite acidic, so are moderate GI; fruit juice and chocolate milk both have quite low GI values.
    • We are NOT suggesting that these items cannot be used as a low treatment, however, it is important to realize that they will take longer to raise blood glucose.
(For more information, see Nutrition/Intro to Glycemic Index.)

  • Potential other (non-candy) sources of fast-acting carbs (i.e. high GI foods) for your family to try include: Pretzels, dry cereal (Corn Pops®, Rice Chex®, etc)
  • The large Rockets® contain dextrose, and are quite similar to brand-name glucose tablets in terms of size, shape and key ingredients. However, they are significantly less expensive than “official” glucose tablets. 
tips from the trenches of type 1 diabetes


 
We have found large Rockets
® for $0.50-0.75/roll at various Loonie stores.


  • Portability:
    • Easy to take with you away from home are: candy such as Rockets®, Skittles®, and jelly beans.
    • Many juice treats are sold in individual serving-size packages which are portable and convenient.
    • When single-serving sizes of candy come out at Halloween, stock up for the coming year.
    • For easy storage and portability, you could use an empty Dex4® container or a Mini M&M® container and fill it with large Rockets® (or other options). This will protect the candy from crushing and light moisture.
    • Junior Juice® boxes have 12-13 g of carbohydrate (depending on which flavour), so are closer to the target amount of low treatment than full-size juice boxes. 
    • For older kids who do not want to be referred to as “junior”, Kool-aid Jammer® pouches are easy to take along and have 17-18g of carbohydrate per pouch.
  • Very Young Children:
    • For infants who are not ready for hard candies and who may resist drinking juice, also consider sugar water or maple syrup given through a medicine dropper. Also available at most drugstores are handy medication-delivery gadgets for infants – essentially a bottle nipple attached to a small measuring cup.
(Michelle Says: For our then-14-month-old son, my husband and I mixed 2 tsp. of sugar in about ¼ cup of water and left these in the fridge for easy access when needed for low treatment. We would use a medicine dropper to feed him the sugar-water if he resisted drinking juice from a bottle.)


    • For toddlers who are not yet ready for hard-candies, Gerber’s Graduates Juice Treats® are a soft, easily chewed source of rapid-acting carbohydrate. Each package contains 18 juice treats for a total of 24g carbohydrate. They may be found in the baby/toddler food aisle of most major food stores.

(Michelle Says: For each low treatment we would give our pre-schooler 8 juice treats (almost half a package). These are still a favourite low treatment for our son. Although he can get quite emotional during a low and has refused juice, sugar water, Rockets®, and other things, to this day he has never refused to eat “juicy gellies”.)

Important Notes:

  • A low blood glucose can happen at any time. You and your child should always carry a treatment for low blood glucose (glucose tablets, candy, juice, etc.).

(For more information, see The Basics/Low Kits.)

  • Your child should wear a bracelet or necklace saying that he or she has diabetes and is being treated with insulin. There are lots of fun, flexible, attractive options for wearing medical ID these days! 




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The above information was significantly modified, with permission, from The Alberta Children’s Hospital Diabetes Clinic information handouts.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.



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