Children's Hospital Colorado

Hypoglycemia in Children

What is hypoglycemia?

Hypoglycemia is also known as low blood sugar. It happens when a person's level of glucose gets too low. Glucose is sugar in the blood that comes from the food a person eats. Glucose is important because it’s the main source of fuel for the body's cells. While some body tissues can also use fat or protein for energy, the brain can only use glucose.

If a person's blood sugar level gets too low, they need immediate treatment to avoid the risk of seizure, unconsciousness or brain injury.

Hypoglycemia in children most often happens as a complication of diabetes. However, it can also happen in children without diabetes.

What causes hypoglycemia in children?

In children and adolescents with diabetes, hypoglycemia can occur if they take too much insulin. Insulin is the hormone that allows the body's cells to absorb glucose. Taking too much insulin makes blood sugar levels drop. We sometimes call this an insulin reaction. This can happen when children:

  • Take their insulin at the wrong time
  • Take the wrong kind of insulin
  • Incorrectly monitor their blood glucose level

Children and teens with diabetes can also experience hypoglycemia if they:

  • Miss or delay a meal, or eat too few carbohydrates
  • Exercise more than usual
  • Experience vomiting or diarrhea
  • Take a hot bath or shower after an insulin injection, causing it to absorb faster
  • Inject insulin into muscle rather than fat, causing it to absorb faster
  • Drink alcohol, which impairs the body's ability to use glucose
  • Take certain medicines
  • Have other health conditions

For children and adolescents without diabetes, hypoglycemia is uncommon, but it can happen if they:

  • Don't eat enough, particularly because of illness or fasting
  • Experience long-term starvation, which may occur with eating disorders
  • Drink alcohol, especially without food
  • Take certain medicines, especially if they have kidney failure
  • Have health conditions like hepatitis or kidney disorders
  • Have low levels of hormones because of problems with their pituitary or adrenal glands
  • Have a pancreatic tumor, which is rare

Who gets hypoglycemia?

Children with type 1 diabetes have the highest risk. Children with type 2 diabetes may also get hypoglycemia if they rely on insulin or other medicines to control their blood sugar.

Children without diabetes most often experience hypoglycemia by eating much less than they should because of illness or eating disorders.

Babies may also be at risk if they are born to mothers with diabetes or if they have other health complications. These include prematurity or an unusually small or large size for their gestational age.

What are the signs and symptoms of hypoglycemia?

Pediatric hypoglycemia symptoms range from mild to severe, depending on the extent of the condition. They may include:

  • Irritability
  • Dizziness
  • Headache
  • Shakiness or clumsiness
  • Hunger
  • Pale skin
  • Sweating
  • Fast or irregular heart rate
  • Confusion or difficulty paying attention
  • Blurry vision
  • Seizure
  • Loss of consciousness

If your child experiences many episodes of hypoglycemia over time, they may stop getting symptoms. This is a condition called hypoglycemia unawareness. It happens when the body stops releasing adrenaline in response to low blood sugar. Adrenaline is the hormone that causes symptoms such as fast heart rate and sweating. Without adrenaline, there is no warning that your child needs to raise their blood sugar level. As it continues to drop, they will go into severe hypoglycemia, which requires emergency treatment.

How is pediatric hypoglycemia diagnosed?

Children and adolescents who monitor their blood sugar at home to manage diabetes often use a glucose meter. This is a portable machine that measures the glucose in their blood. This allows families to detect hypoglycemia at home. A typical blood sugar range is between 70 and 140 mg/dl (milligrams of glucose per deciliter of blood). However, your child's ideal range may vary depending on their age and condition. We will help you determine the best range for your child.

For children without diabetes, we may make a pediatric hypoglycemia diagnosis after a physical exam, medical history and blood test. We will check your child's blood sugar and may also test their insulin production. We will also see if we can relieve your child's symptoms by raising their glucose level. We may have your child undergo supervised fasting at the hospital, to safely monitor any changes in their glucose level.

How is hypoglycemia treated in children?

Pediatric hypoglycemia treatment depends on the cause and the seriousness of the condition.

In most mild cases, your child can bring their blood sugar level up by eating or drinking something sugary such as candy, juice or glucose tablets. They can then keep their blood sugar stable by eating regularly. They should get balanced nutrition that includes complex carbohydrates, fat and protein.

Children and adolescents with diabetes will also need to test their blood sugar often. They should learn to recognize the early symptoms of hypoglycemia so they can treat it quickly.

When hypoglycemia is severe, your child needs immediate medical treatment. They may need an injection of the hormone glucagon, which can bring their glucose levels up quickly. This is important if your child can't eat or drink because of a seizure or loss of consciousness. We may prescribe a glucagon kit to your family to keep on hand for such emergencies. If we hospitalize your child, we may provide glucose intravenously (through a tube into their vein) to keep them stable.

If hypoglycemia happens to your child often, we will try to determine why. Some families may need to improve their diabetes management. We may recommend changes to your child's diet or medicine, or work with your child to better manage their diabetes.

When your child has a different reason for their hypoglycemia, we will work with you to manage that problem. We may recommend changes to your child’s lifestyle or medicine, depending on their needs.

Why choose Children's Hospital Colorado for your child's hypoglycemia treatment?

Here at Children's Colorado, each child is an individual. We carefully consider your child’s unique medical condition, overall health and emotional well-being in our assessments. We then work with your family to determine the best course of treatment for your child. Sometimes, your child may not need any treatment, but rather close observation of their blood sugar levels and health.

Our multidisciplinary care team includes experts in pediatric endocrinology, as well as related specialties from throughout our hospital including nutrition, mental health and diabetes education. We provide a full range of medical, radiologic and surgical therapies, as well as medical support for our patients 24 hours a day, 7 days a week.