Type 1 Diabetes in Children and Hypoglycemia
In children with type 1 diabetes, the pancreas fails to produce sufficient insulin, which is a hormone that is responsible for moving the glucose or sugar from the blood into the cells of the body for producing energy.(1,2,3) A lack of insulin can cause your blood sugar levels to rise, a condition known as hyperglycemia. Hyperglycemia can cause numerous health problems if left untreated, including causing damage to your nerves, blood vessels, and organs like kidneys and eyes.(4,5)
Children with type 1 diabetes need a lot of help to keep track of their carbohydrate intake and need to be taught the importance of doing regular blood sugar checks. If they are too young, their parents or guardians must understand the importance of regularly monitoring the blood glucose levels. The goal of blood sugar control in children with type 1 diabetes is to prevent the blood sugar levels from spiking too high.
In children, an average blood sugar level is around 70 to 140 milligrams per deciliter (mg/dL). This range varies slightly depending on the child’s age, what diabetes medications they are on, and what foods they eat.(6)
Type 1 diabetes requires your child to keep taking regular insulin to keep their blood sugar levels stable. However, in the long run, regular insulin treatment is known to cause another potential complication, which is hypoglycemia, or low blood sugar. The risk of hypoglycemia is exceptionally high if the dosage of insulin is on the higher side. Hypoglycemia occurs when a child’s blood sugar level falls below 70 mg/dL.(7)
Low blood sugar is a common problem in children with type 1 diabetes, but it is a manageable and treatable condition. Here are the signs to recognize and what to do in case your child has hypoglycemia.
Causes of Hypoglycemia
Hypoglycemia, sometimes also referred to as an insulin reaction, is a condition that occurs when your blood sugar levels fall below normal. The most common cause of hypoglycemia is taking too much of a blood sugar-lowering medication or too much insulin. Taking the wrong type or wrong dosage of insulin can also lead to a drop in blood sugar levels.(8)
Children may also get hypoglycemia due to various other factors, including:
- Having diarrhea or vomiting
- Eating too little food
- Missing meals or erratic eating pattern
- Not counting their carbohydrate intake properly
- Exercising too much without eating enough and without monitoring their blood glucose levels
- Getting injured
- Taking diabetes medications like sulfonylureas or others
Why Is Hypoglycemia A Problem For Children?
Our bodies require energy to function, and to make the energy it needs glucose. Glucose is responsible for fueling every organ and cell in the body, especially the brain. When the blood sugar levels fall, a child’s brain is unable to function correctly. If hypoglycemia is left untreated, it can cause severe complications, including organ damage. Severe hypoglycemia is an emergency that needs immediate medical assistance. If severe hypoglycemia sets in, it can cause serious complications, including:
It is possible to prevent severe hypoglycemia. You can make sure that your child does not experience an episode of hypoglycemia by watching out for signs of low blood sugar and treating it immediately. Your child’s doctor will also inform you about keeping an emergency medication known as glucagon. Glucagon is used to treat cases of severe hypoglycemia with immediate effect.(9)
Recognizing the Symptoms of Hypoglycemia
Many times, young children are unable to identify that their blood sugar levels are dropping. They are also unable to communicate appropriately about how they are feeling. Here are some signs to watch out for that indicate your child’s blood sugar levels are too low:
- Blurry vision
- Nausea and/or vomiting
- Crying for no reason
- Pale skin
- Changes in behavior
- Trouble focusing or difficulty in paying attention
A quick blood sugar check can let you know whether the child has hypoglycemia or not. Since there are many other problems also that can cause such symptoms, you should give your doctor a call if you are unsure about whether the child has low blood sugar. Also, call the doctor if giving glucose to your child does not improve the symptoms.(10)
Treating Hypoglycemia in Children
For treating hypoglycemia in children, you should give your child food that contains quick-absorbing sugar. These include:
- Cake icing
- Hard candy
- Orange juice or any other juice
In older children, you can give one of these foods or beverages:
- Glucose tablets
- Skittles or other similar candies
Ask your doctor about how much sugar should be given in case your child develops hypoglycemia. This dosage depends on your child’s weight and age, and it is essential to get the exact amount from your doctor because this has to be specific to your child and their requirements. According to the American Diabetes Association:(11)
- Infants ideally need about 6 grams of sugar
- Toddlers need 8 grams of sugar
- Small children up to the age of 10 years may need to be given 10 grams of sugar
- Older children and teenagers need 15 grams of sugar, which is also the same dosage recommended for adults.
You should wait for at least 15 minutes after giving your child the sugary food or drink. After that, check their blood sugar level again. If you find that the blood sugar is still low, then give them more. Keep checking their blood sugar levels every 15 to 20 minutes until it crosses 100 mg/dL.
Once your child’s blood sugar levels are back to normal, it is important to keep these levels stable. You can do this by giving your child a snack that contains a variety of complex carbohydrates, protein, and fat. Most doctors suggest giving a cheese sandwich on whole-grain bread or peanut butter on whole-wheat crackers.(12)
How to Prevent Hypoglycemia in Children with Type 1 Diabetes?
Most children with type 1 diabetes will experience an episode of hypoglycemia at some point or another. However, if your child is prone to getting low blood sugar, it is important to ask your child’s doctor about whether there is a need to change the current treatment.
In such cases, it is also important to keep testing your child’s blood sugar levels throughout the day to ensure that you are giving them the right dosage of insulin. Also, make sure that you or your child are aware of how to do the test correctly. It is always a good idea to go in for a refresher on how to test once in a while from your doctor or a diabetes nurse.
It is important that you stay on top of your child’s insulin routine. If your child is older and taking the medication themselves, make sure that they are taking the right dosage and at the right time of the day every day to keep their blood sugar levels balanced.
Here are some steps you can take to prevent hypoglycemia in your child:
- Make sure your child uses the glucose testing strips that match the glucometer they are using to test.
- Make sure your child is doing regular blood sugar checks and is taking their insulin as per the schedule recommended by their doctor.
- Make sure your child is having enough to eat during the day and is not skipping their meals. Avoid having an erratic eating pattern throughout the day.
- Make sure your child is doing a proper blood sugar check before they exercise. If the blood sugar turns out to be low before exercising, your child should be having a small snack with them to bring it back up to within a normal range.(13,14)
- Make sure your child is monitoring their blood sugar levels before going to bed, and also overnight if needed.
It is necessary to inform the teachers at your child’s school about how to identify and recognize the signs of low blood sugar. You should also always send your child to school with juice, candy, or any other quick-acting sugary snack that can prevent hypoglycemia from becoming worse when an episode does take place.
In cases of severe hypoglycemia, your child’s doctor will recommend that you keep glucagon medication handy for your child. Glucagon is prescribed for rapidly treating severe hypoglycemia. It is also a good idea to store some glucagon medication with teachers or other caregivers at places your child frequently visits, such as school or any after-school activities. Your child should also be aware that there should be someone in the school staff who can administer them the medication if they so require.
What To Do In Emergencies?
If your child frequently gets hypoglycemia, you should consult your doctor about finding out if their current treatment plan needs to be changed. Also, inform your doctor if it is often challenging to manage your child’s blood sugar levels. The doctor may need to make certain changes to your child’s treatment plan in such a case.
If your child has severe hypoglycemia, do not wait, and seek urgent medical help. This can be a life-threatening emergency if left untreated or you delay seeking medical assistance. Call your local emergency number at once.
Here are the signs of severe hypoglycemia in children:
- Losing consciousness
If your child is showing symptoms of severe hypoglycemia, do not force them to eat or drink any sugary things as they may choke. They will need an adult to administer them glucagon, the emergency medication that helps to increase blood sugar rapidly. If you have glucagon medication, you should administer it to your child immediately or call for medical help at once.
If your child has type 1 diabetes, it is essential that you keep glucagon medication handy for potential emergencies. If you don’t know about glucagon medication, talk to your child’s doctor about how to get it.
Low blood sugar levels can cause hypoglycemia in children with type 1 diabetes. Such a condition may be a result of taking too much insulin or taking another medication to lower the blood sugar levels. Hypoglycemia in children with type 1 diabetes is quite common and a treatable condition. However, it is important to recognize and familiarize yourself and your child with the symptoms of hypoglycemia so that you and your child are able to manage the blood sugar levels effectively. Keeping their blood sugar levels in balance can help your child stay healthy and avoid any serious complications of type 1 diabetes.
- Daneman, D., 2006. Type 1 diabetes. The Lancet, 367(9513), pp.847-858.
- Atkinson, M.A., Eisenbarth, G.S. and Michels, A.W., 2014. Type 1 diabetes. The Lancet, 383(9911), pp.69-82.
- Dabelea, D., Mayer-Davis, E.J., Saydah, S., Imperatore, G., Linder, B., Divers, J., Bell, R., Badaru, A., Talton, J.W., Crume, T. and Liese, A.D., 2014. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 311(17), pp.1778-1786.
- Faustino, E.V. and Apkon, M., 2005. Persistent hyperglycemia in critically ill children. The Journal of pediatrics, 146(1), pp.30-34.
- Gioacchini, F.M., Albera, R., Re, M., Scarpa, A., Cassandro, C. and Cassandro, E., 2018. Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: truth or suggestion? A literature review. Acta diabetologica, 55(12), pp.1201-1207.
- Abdul‐Rasoul, M., Habib, H. and Al‐Khouly, M., 2006. ‘The honeymoon phase’in children with type 1 diabetes mellitus: frequency, duration, and influential factors. Pediatric diabetes, 7(2), pp.101-107.
- Amin, R., Ross, K., Acerini, C.L., Edge, J.A., Warner, J. and Dunger, D.B., 2003. Hypoglycemia prevalence in prepubertal children with type 1 diabetes on standard insulin regimen: use of continuous glucose monitoring system. Diabetes Care, 26(3), pp.662-667.
- Battelino, T., Nimri, R., Dovc, K., Phillip, M. and Bratina, N., 2017. Prevention of hypoglycemia with predictive low glucose insulin suspension in children with type 1 diabetes: a randomized controlled trial. Diabetes care, 40(6), pp.764-770.
- Kedia, N., 2011. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes, metabolic syndrome and obesity: targets and therapy, 4, p.337.
- Cryer, P.E., 1999. Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness. Endocrinology and metabolism clinics of North America, 28(3), pp.495-500.
- Diabetes.org. 2020. Hypoglycemia (Low Blood Glucose) | ADA. [online] Available at: <https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia> [Accessed 13 November 2020].
- Kaufman, F.R., Austin, J., Neinstein, A., Jeng, L., Halvorson, M., Devoe, D.J. and Pitukcheewanont, P., 2002. Nocturnal hypoglycemia detected with the continuous glucose monitoring system in pediatric patients with type 1 diabetes. The Journal of pediatrics, 141(5), pp.625-630.
- Taplin, C.E., Cobry, E., Messer, L., McFann, K., Chase, H.P. and Fiallo-Scharer, R., 2010. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. The Journal of pediatrics, 157(5), pp.784-788.
- American Diabetes Association, 2006. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes care, 29(10), pp.2200-2204.
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