Hypoglycemia in Children

What is hypoglycemia and low blood sugar?

Hypoglycemia occurs when the blood sugar is too low to fuel the brain and the body. Glucose is the main source of fuel for the body. The normal range of blood sugar, depending on the timing and nutritional content of the last meal consumed, is approximately 70 to 140 mg/dl (milligrams of glucose per deciliter of blood). If you have type 1 diabetes, your goal blood sugar range may be slightly different. Infants and small children with type 1 diabetes will have different goal ranges than adolescents or adults. However, consult your child's doctor for more specific information.

Hypoglycemia may be a condition by itself, or may be a complication of diabetes or another disorder. Hypoglycemia is most often seen as a complication of overdoing insulin in a person with diabetes, which is sometimes referred to as an insulin reaction.

What causes hypoglycemia?

Causes of hypoglycemia in children with diabetes may include the following:

  • Too much medication; for instance, too much insulin or oral diabetes medication 

  • Medication mistakes. All families will, at some point, give the wrong kind of insulin for a meal or at bedtime.

  • Inaccurate blood-glucose readings 

  • A missed meal

  • A delayed meal

  • Too little food eaten, as compared to the amount of insulin taken

  • More exercise than usual

  • Diarrhea or vomiting 

  • Injury, illness, infection, or emotional stress 

  • Other medical problems sometimes seen in people with type 1 diabetes, such as celiac disease or an adrenal problem.

An additional cause of hypoglycemia in neonates and toddlers includes a group of conditions called hyperinsulinism. This may occur as a result of abnormal cell development of the special "beta" cells in the pancreas that secrete insulin or from a mass in the pancreas. Hypoglycemia due to endogenous insulin in an older child may be caused by insulinoma or ingestion of sulfonylureas. Some children are also born with errors in their beta-cell metabolism that can lead to hypoglycemia. Other rare genetic disorders can also cause hypoglycemia.

Other causes of hypoglycemia in children are rare. However, hypoglycemia may occur after strenuous exercise, during prolonged fasting, or as a result of accidental ingestions, taking certain medications, or abusing alcohol.

Why is hypoglycemia a concern?

The brain depends on blood glucose as its main source of fuel. Too little glucose can impair the brain's ability to function. Severe or prolonged hypoglycemia may result in seizures and serious brain injury.

What are the symptoms of hypoglycemia?

The following are the most common symptoms for hypoglycemia. However, each child may experience symptoms differently. Symptoms may include:

  • Shakiness

  • Dizziness

  • Sweating

  • Hunger

  • Headache

  • Irritability

  • Pale skin color

  • Sudden moodiness or behavior changes, such as crying for no apparent reason

  • Clumsy or jerky movements

  • Difficulty paying attention, or confusion

  • Tingling sensations around the mouth

  • Seizure

The symptoms of hypoglycemia may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How is hypoglycemia diagnosed?

In addition to a complete medical history and physical examination, certain blood tests are performed to diagnose hypoglycemia.

When a child with diabetes has symptoms of hypoglycemia, the cause is usually an insulin reaction.

For those who have symptoms of hypoglycemia and do not have diabetes, the underlying disorder is diagnosed by:

  • Measuring blood sugar and multiple hormone levels while the child is experiencing the symptoms

  • Observing that the symptoms are relieved when the child eats food or sugar

  • Some patients with hypoglycemia must be admitted to the hospital to undergo a supervised fasting study to reproduce the hypoglycemia and collect the needed blood tests in a safe manner.

Specialised lab tests to measure insulin action may also be performed.

What is the treatment for hypoglycemia?

Specific treatment for hypoglycemia will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the disorder

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disorder

  • Your opinion or preference

For children with diabetes, the goal of treatment is to maintain a safe blood sugar level. This involves testing blood sugar often, learning to recognize oncoming symptoms, and treating the condition quickly, based on instructions given by your child's doctor.

To treat low blood sugar immediately, your child should eat or drink something that has sugar in it, such as orange juice, milk, cake icing, or a hard candy.


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