Low blood sugar means that the level of sugar (glucose) in your child's blood has dropped below what his or her body needs to function normally. When your child's blood sugar level drops below 70 milligrams per deciliter (mg/dL), he or she most likely will have symptoms, such as feeling tired, weak, or shaky. Very low blood sugar levels (below 20 mg/dL) can develop quickly and are emergency situations that require immediate care. You can give your child a glucagon shot to bring his or her blood sugar back up. Follow the instructions that come with the glucagon kit. Without immediate care, a very low blood sugar level can lead to coma and death.

Sometimes people with diabetes develop low blood sugar levels during the night. If your child's level drops during the night, he or she may wake up in a cold sweat and feel weak. But some children sleep through it because the body uses stored sugar to raise their blood sugar level back to their target range. If this happens, your child may wake up in the morning with only a headache and possibly high blood sugar.

What causes low blood sugar?

Very low blood sugar can develop rapidly (within minutes). It can occur if your child:

• Takes too much insulin.
• Skips or delays a meal or snack.
• Exercises too much without eating enough food.

Children may have symptoms of low blood sugar if their blood sugar drops to a lower level than usual. For example, if your child's level has been in the 300s for a week and it drops suddenly to 100, he or she may have symptoms of low blood sugar. Even though 100 is in the normal range, it is much lower than your child is used to. It is also possible that after having diabetes for many years, your child may not have symptoms of low blood sugar until the level is very low. When the blood sugar level is very low, your child may be too confused to remember how to treat low blood sugar.

Continue to Why?

When children's blood sugar levels fall below 70 mg/dL, their bodies react the same as when they are very afraid, angry, or anxious. These symptoms of mild low blood sugar often last for only a short time if your child eats or drinks food containing sugar. An emergency situation will not likely develop, and your child won't have any lasting effects.

If your child's blood sugar continues to drop (below 40 mg/dL), the brain may receive too little sugar to work properly, and judgment and muscle coordination are affected. Children may not realize that their blood sugar is too low and may not think they need to eat food to raise the level. You or someone else may have to help your child eat or drink something.

If your child's blood sugar level continues to drop (below 20 mg/dL), he or she can have a seizure or lose consciousness. If your child doesn't receive prompt emergency care, such as a glucagon shot, he or she may go into a coma and possibly die.

Continue to How?

Low blood sugar levels can develop rapidly, within minutes. Treat low blood sugar symptoms as soon as you notice them.

Here are some ways to manage a low blood sugar emergency.

Be prepared

• Keep some quick-sugar food with your child at all times. Quick-sugar food can raise your child's blood sugar level by 30 mg/dL in 15 minutes.
• Know the symptoms of low blood sugar. Post these symptoms where the list can be seen often, and have your child carry a copy at all times. Add any symptoms that your child has that aren't on the list.
• Have your child wear medical identification, such as a medical alert bracelet, in case your child's blood sugar drops very low and he or she needs help. For more information, see the Where to go from here section for information on purchasing medical identification.
• Keep glucagon on hand. If your child becomes unconscious when his or her blood sugar is very low, someone may need to give your child an injection of glucagon to raise the blood sugar level. Keep the instructions for how to give glucagon with your child's glucagon. Also, check the expiration date on the glucagon—most glucagon kits need replacing every 6 months to a year.
• Teach your child's caregivers how to check blood sugar. Have instructions for using the blood sugar meter stored with the meter so the caregiver can review the instructions if needed.
• Post the emergency care for low blood sugar instructions in a convenient place at home and at school.

Treat low blood sugar early

Check your child's blood sugar level if you think it may be low, even if you don't see any symptoms. If your child's blood sugar level is below 70 mg/dL:

• If your child is alert, give him or her some quick-sugar food. Liquids raise your child's blood sugar faster than solid foods.
  • Check your child's blood sugar level after 15 minutes. It will take about 15 minutes for the sugar in the food to get into your child's bloodstream.
  • Wait another 15 minutes and check your child's blood sugar level again. If his or her blood sugar is still below 70 mg/dL, have your child eat or drink something that contains sugar and protein, such as milk.
• If your child is not alert, follow the appropriate guidelines:
  • If your child is too weak or confused to treat low blood sugar, see emergency care for low blood sugar.
  • If your child uses an insulin pump, stop it or put it in "suspend" mode as previously instructed. If this is not possible, disconnect the pump from the catheter at the injection site.

After the episode

• When your child's blood sugar has returned to above 70 mg/dL, feed him or her a regular meal or a snack with protein, such as a turkey or ham sandwich. This will help keep his or her blood sugar from dropping again.
• Write down your child's symptoms and what you did. Use the low blood sugar level record (What is a PDF document?).
• Let the doctor know if your child is having frequent low blood sugar problems. His or her medicine or insulin pump may need to be changed or adjusted.

Continue to Where?

Talk with your child's doctor

If you have questions about this information, take it with you and discuss it with the doctor. You may want to mark areas or make notes in the margins of the pages where you have questions.

If you don't already have glucagon at home, ask your child's doctor for a prescription. Make sure your child's caregivers know how to give a glucagon shot if an emergency develops.

If you would like more information on dealing with low blood sugar levels, the following resources are available:

Organization

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone:	1-800-DIABETES (1-800-342-2383)
Email:	AskADA@diabetes.org
Web Address:	www.diabetes.org
The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.