How to Manage Low Blood Sugar (Hypoglycemia) in Diabetic Children
Quick Answer: Low blood sugar (below 70 mg/dL) requires immediate treatment. Follow the "Rule of 15": give 15g of fast-acting carbs (juice, glucose tablets, or candy), wait 15 minutes, recheck blood sugar, and repeat if still low. Always carry emergency supplies. For severe hypoglycemia (unconsciousness or seizure), don't give food by mouth - use glucagon and call emergency services.
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Understanding Hypoglycemia
Watch: Managing Blood Sugar in Children
Hypoglycemia (low blood sugar) is a common challenge for children with diabetes. Recognizing and treating it quickly prevents serious complications.
What Is Low Blood Sugar?
Level
Category
Action
Below 70 mg/dL
Low
Treat immediately
Below 54 mg/dL
Very low
Treat urgently
Below 40 mg/dL
Severely low
Emergency
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Why Does It Happen?
Common Causes
Cause
How It Happens
**Too much insulin**
Dose error or changed needs
**Skipped/delayed meal**
Insulin acting without food
**Extra exercise**
Burns glucose faster
**Illness**
Vomiting, not eating
**Hot weather**
Affects insulin absorption
**Alcohol** (teens)
Blocks liver glucose release
High-Risk Situations
After sports or physical activity
During illness
When meal timing changes
After insulin dose adjustments
During sleep (nighttime lows)
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Recognizing Low Blood Sugar
Early Warning Signs
Symptom
What It Feels Like
**Shaky/trembling**
Hands feel wobbly
**Sweaty**
Cold, clammy skin
**Hungry**
Sudden intense hunger
**Pale**
Face looks washed out
**Fast heartbeat**
Heart pounding
**Dizzy/lightheaded**
Room spinning
**Irritable/moody**
Sudden behavior change
Moderate to Severe Signs
Symptom
Action Needed
**Confusion**
Treat now, don't wait
**Slurred speech**
May need help treating
**Difficulty walking**
Sit child down, treat
**Blurred vision**
Treat immediately
**Drowsiness**
Act fast
**Unconscious**
Emergency - use glucagon
**Seizure**
Emergency - use glucagon
How Children May Describe It
Different ages express lows differently:
Toddlers: Crying, clingy, tantrums, won't eat
School-age: "My tummy feels funny," "I feel weird"
Teens: Recognize symptoms but may deny them
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The Rule of 15: Treatment Protocol
Step-by-Step Treatment
Step 1: Give 15g Fast-Acting Carbs
Choose ONE:
4 glucose tablets
1/2 cup (4 oz) fruit juice
1/2 cup regular (not diet) soda
1 tablespoon honey or sugar
6-8 hard candies
Glucose gel packet
Step 2: Wait 15 Minutes
Stay with child
Keep them calm
Don't give more food yet
Step 3: Recheck Blood Sugar
If still below 70: repeat Step 1
If above 70: give a snack if next meal is more than 1 hour away
Step 4: Follow Up Snack
If blood sugar is now normal but next meal is far:
Crackers and cheese
Peanut butter sandwich
Milk and crackers
What NOT to Do
Don't
Why
Give chocolate
Fat slows sugar absorption
Give large amounts
Can cause rebound high
Wait to see if it improves
Can progress rapidly
Give food if unconscious
Choking risk
Panic
Child needs calm help
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Treating Severe Hypoglycemia
When It's an Emergency
Severe hypoglycemia means:
Child is unconscious
Child is having a seizure
Child cannot swallow safely
Glucagon: Emergency Treatment
What is Glucagon?
A hormone that raises blood sugar by releasing stored glucose from the liver.
How to Give:
Type
How to Use
**Injectable glucagon**
Mix powder and liquid, inject into muscle
**Nasal glucagon**
Spray into one nostril
**Auto-injector**
Follow device instructions
Emergency Steps
Position child safely - On side if vomiting risk
Don't put anything in mouth - No food, no drinks
Give glucagon - Follow package instructions
Call emergency services - Even if child improves
Once conscious - Give fast-acting carbs, then snack
Report to doctor - All severe episodes need review
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Prevention Strategies
General Prevention
Strategy
How It Helps
**Check blood sugar regularly**
Catch lows before symptoms
**Don't skip meals**
Food balances insulin
**Adjust for exercise**
Reduce insulin or add carbs
**Carry treatment**
Always have glucose ready
**Wear medical ID**
Helps others help you
Before, During, After Exercise
When
What to Do
**Before**
Check blood sugar; eat snack if below 100
**During**
Check every 30-60 min for long activity
**After**
Check; may need extra carbs for hours
Nighttime Lows
Prevent overnight hypoglycemia:
Check blood sugar at bedtime
Have a bedtime snack if needed
Set alarm to check during night if concerned
Talk to doctor about insulin adjustments
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Emergency Kit Essentials
What to Carry Always
Item
Purpose
Glucose tablets
Fast treatment
Juice box
Alternative treatment
Glucagon kit
Severe emergencies
Blood glucose meter
Confirm low
Medical ID card
Information for others
Keep Supplies In
Child's backpack
Your purse/bag
Car
School nurse's office
Grandparents' house
Sports bag
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Teaching Others to Help
What Caregivers/Teachers Need to Know
Provide written instructions for:
Signs of low blood sugar
How to treat mild lows
When to call you
When to call emergency services
How to use glucagon (if trained)
Information Card Template
```
[Child's Name] has diabetes
LOW BLOOD SUGAR SIGNS:
Shaky, sweaty, pale, confused, irritable
WHAT TO DO:
Give juice/glucose tablets immediately
Wait 15 minutes
Call parent if not improving
EMERGENCY (unconscious/seizure):
Do NOT give food
Give glucagon if trained
Call emergency services
Call parents
```
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When to Seek Medical Help
See Doctor If:
Frequent lows (more than 2-3 per week)
Lows without explanation
Nighttime lows
Severe low requiring glucagon
Lows before meals/at same time daily
Fear of lows affecting daily life
Adjust Treatment Plan
Work with your diabetes team to:
Review insulin doses
Check timing of insulin
Evaluate food intake
Discuss exercise patterns
Consider continuous glucose monitoring
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Frequently Asked Questions
Q: How low is too low for a child?
A: Any blood sugar below 70 mg/dL needs treatment. Below 54 is urgent. Below 40 or with severe symptoms is an emergency.
Q: Can my child tell they're having a low?
A: Many children learn to recognize their symptoms. Some don't feel lows ("hypoglycemia unawareness"). Frequent monitoring helps catch these.
Q: Should I wake my child to check blood sugar at night?
A: Discuss with your doctor. Some situations warrant nighttime checks: after exercise, illness, insulin changes, or a history of nighttime lows.
Q: What if my child refuses treatment during a low?
A: Confusion and irritability are symptoms of low blood sugar. Stay calm, be gentle but firm. If child won't cooperate and is conscious, give whatever fast carbs you can. If unconscious, use glucagon.
Q: Is it okay to give extra sugar "just in case"?
A: Check blood sugar first if possible. Unnecessary treatment causes high blood sugar. If you can't test and child has symptoms, treat.
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Key Takeaways
Act fast - Don't wait; treat lows immediately
Rule of 15 - 15g carbs, wait 15 minutes, recheck
Fast-acting carbs - Juice, glucose tablets work quickly
Know severe signs - Confusion, unconsciousness, seizure
Use glucagon for emergencies - Know how before you need it
Always carry supplies - Glucose and glucagon everywhere
Teach others - Caregivers need to know what to do
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This article was reviewed by pediatricians at Babynama. Last updated: January 2026
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