Low Blood Sugar:
how to identify it &
how to treat it
adapted from the patient handouts from the AB Children's Hospital Diabetes Clinic
As a D-parent, one of my biggest and most persistent worries is low blood glucose. But over the years our family has learned what we need to do to reduce the risk of lows occurring, and to deal with lows effectively so that their inevitable occurrence doesn't become a diabetes emergency.
Low blood glucose is also called “hypoglycemia.” You may hear some people refer to it as an “insulin reaction”.
Causes of Low Blood Glucose:
- a missed or delayed meal or snack
- 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
- vomiting from an illness
Knowing the causes of low blood glucose can help prevent them.
More on managing blood sugars during illness:
Illness Management section
Symptoms of Low Blood Glucose:
Signs and symptoms of mild to moderate low blood glucose are:
- sweating
- trembling
- hunger
- weakness
- paleness
- dizziness
- headache
- blurred vision
- mood changes
- drowsiness
- clumsiness
- confusion
Tips from the Trenches
I 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 Signs & Symptoms of a SEVERE Low:
What do I do when my child has low blood sugar?
- If your child has any of the above symptoms, check her blood glucose (BG).
- If BG is less than 4.0 mmol/L, treat immediately (according to “Treatment Options for Low Blood Glucose” below).
- Wait 15 minutes and recheck blood glucose. If it is less than 4.0 mmol/L, repeat treatment.
- If your child has 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.
- 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 (which contains 15g of carbs) and a protein. For example, crackers and cheese, or ½ of a peanut butter sandwich, would make a good snack. This is particularly important for those on an intermediate-acting peaking insulin (N/NPH).
The reason it's wise to wait 15 minutes before eating a snack is to allow the fast-acting sugar to work quickly to raise blood glucose, before any protein and fat in the snack slow down digestion.
How do I treat my child's low blood sugar?
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 another name for “glucose”.)
The amount of rapid-acting carbohydrate needed to treat a low blood sugar is based on a child's weight:
- Children weighing less than 15 kg (33 lbs), which may roughly correspond to infants and toddlers: 5 grams of low treatment (rapid-acting carbohydrate). Liquids and syrups are recommended for infants and young toddlers. These can be given by a medicine dropper or a liquid medicine dispenser.
- Children weighing from 15 to 30 kg (33-66 lbs), which may roughly correspond to preschoolers/children around 6 years of age and younger: 10 grams of low treatment (rapid-acting carbohydrate)
- Children weighing more than 30 kg (66 lbs), which may roughly correspond to children 6 or 7 years of age and older: 15 grams of low treatment (rapid-acting carbohydrate)
Tip from the Trenches
When our son was just over 5 years old, we found that 8g carbs was the ideal low treatment in most instances. That continued to be a good match for another 5 years; the same was true at 10 years old. 8g still did the job, and more "uncovered" carbs than that often led to high blood sugar.
-Michelle
Examples of Fast-Acting Carbs
| Child weight below 15 kg | Child weight 15 - 30 kg | Child / Teen weight over 30 kg |
|---|---|---|
| ~5 grams carbohydrate | ~10 grams carbohydrate | ~15 grams carbohydrate |
| Containing glucose/dextrose (fastest acting): | ||
| 1 Dex4® Glucose Tablets (= 4g carbs) | 2-3 Dex4® Glucose Tablets (= 8-12g carbs) | 3-4 Dex4® Glucose Tablets (= 12-16g carbs) |
| 1/3 Dex4® Glucose Gel | ||
| 1/3 Dex4® Glucose Liquiblast liquid (= 5g carbs) | 1 bottle Dex4® Glucose Liquiblast | |
| 2 large individual Rockets® (= 6g carbs) | 3 large individual Rockets® (=9g carbs) | 5 large individual Rockets® |
| 10 small Rocket® candies | 1 1/2 packages of small Rockets® | 2 packages of small Rockets® |
| 1/3 cup Gatorade® | 2/3 cup Gatorade® | 1 cup Gatorade® |
| 2 tsp (9g weight) of Nerds® |
1 tbsp (14 g weight) of Nerds® Note: Small premeasured boxes of Nerds are available at Easter or Halloween. |
|
| Containing Sucrose (next fastest-acting): | ||
| 1 tsp sugar in water | 2 tsp. sugar | 3 tsp. sugar |
| 1 tsp syrup | 10 Skittles® | 15 Skittles® |
| 2 large marshmallows | 3 large marshmallows | |
| 3 tbsp regular pop | 1/3 cup regular pop | 1/2 cup of regular pop |
| 6 Gerber’s Graduates Juice Treats® | 5 Jelly Beans® | 7 Jelly Beans® |
| 3 gummy bear candies | 6 gummy bear candies | 9 gummy bear candies |
| 1 gummie worm (=8g carbs) | 2 gummie worms (=16g carbs) | |
| 1 pouch Kool-aid Jammers® | ||
| Containing Fructose (next fastest-acting): | ||
| 3 tbsp orange juice | 1/3 cup orange juice | ½ cup orange juice |
| 3 tbsp apple 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.
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).
- Potential other (non-candy) sources of fast-acting carbs (i.e. high GI foods) for your family to try: Pretzels, dry cereal (Corn Pops®, Rice Chex®, etc), and white crackers (Premium Plus by Mr. Christie).
More on how quickly (or slowly) different foods treat low blood glucose:
Tips from the Trenches
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. 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.
More on portable low treatments:
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 a low treatment. We would use a medicine dropper to feed him the sugar-water if he resisted drinking juice from a bottle. Note that 2 tsp of sugar contains 8g of carbohydrates.)
- 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 remained a favourite low treatment for our son well into kindergarten. Although he can get quite emotional during a low and has refused juice, sugar water, Rockets®, and other things, he 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.).
More on portable low treatments:
- 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!
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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