Most people with diabetes sometimes have low or high blood sugar. In this section, you will learn how to treat mild highs and lows, and how to recognize more serious problems. This section also discusses what to do when your child is sick.
When should you worry about low blood sugar (hypoglycemia)?
Most people with type 1 diabetes have low blood sugar reactions from time to time. These are also known as insulin reactions or hypoglycemia. For more information, please read the page on Hypoglycemia (Low Blood Sugar) in this section.
Give quick-acting sugar to treat low blood sugar
All insulin reactions must be treated right away. Always have a source of fast-acting sugar available, such as juice, dextrose tablets, or even table sugar. For infants or toddlers, some parents keep a tube of cake frosting handy. About 10 to 15 grams of carbohydrates is normally all it takes to treat an insulin reaction.
If possible, check the blood sugar level to confirm hypoglycemia. Treat if your child has symptoms of low blood sugar (see below) and:
- blood sugar lower than 4 mmol/L (about 72 mg/dL) in older children and teens
- blood sugar lower than 6 mmol/L (110 mg/dL) in toddlers or preschoolers
If you cannot check your child’s blood sugar level to confirm an insulin reaction, give a sugar source anyway to be safe. Check your child’s blood sugar as soon as possible afterward and note your child’s response to treatment.
Common signs and symptoms of a mild insulin reaction
- shakiness: “butterflies,” feeling nervous for no reason
- cold, clammy sweatiness, unlike sweat from playing hard
- dilated pupils, “funny-looking” eyes
- mood change: irritable, grouchy, impatient; temper tantrums in younger children
- hunger, and sometimes nausea due to the hunger
- lack of energy: tired, weak, floppy
- lack of concentration
- blurred vision
- pounding heart
- change in skin colour: pale, most noticeable in the face and around the mouth
- disturbed sleep: restlessness, crying out, sleepwalking, or nightmares
Occasionally a severe hypoglycemic reaction occurs when early symptoms of low blood sugar go undetected and untreated. For more information, please read the page on Severe Hypoglycemia in this section.
Signs and symptoms of a severe insulin reaction
- “drunken-like behaviour”: slurred speech, staggering, confusion, combativeness
- low energy: extremely tired, difficult to wake up
- loss of consciousness
- convulsions or seizures
- temporary paralysis down one side of the body
How to treat a severe insulin reaction
This is an emergency situation. Anyone showing signs of a severe insulin reaction needs help right away. The blood sugar is dangerously low, and your child needs sugar. However, if your child is very drowsy, unconscious, or having a convulsion or seizure, do not give juice or any other liquid by mouth, because your child could choke. Rather, turn your child onto her side to prevent choking, and inject glucagon. If a glucagon emergency kit is not available, call an ambulance to take your child to the closest hospital emergency department. There, either a glucose-containing solution will be injected intravenously, or glucagon will be given.
When should you worry about high blood sugar (hyperglycemia)?
No matter how hard you try to get excellent blood sugar results, the levels will be high from time to time. For more information, please read the page on Hyperglycemia (High Blood Sugar) in this section.
Give extra insulin if your child has symptoms of high blood sugar or ketones in the urine
If your child feels well and there are no ketones in the urine, one high blood sugar level once in a while is not a cause for concern. But you need to treat high blood sugar with extra insulin right away if your child has either of the following:
- any symptoms of hyperglycemia, such as thirst, increased urination, or fatigue (see below)
- ketones in the urine
To treat high blood sugar, give your child extra short-acting or rapid-acting insulin (Regular or Humalog or NovoRapid) right away. The diabetes team will help you decide how much insulin to give.
Signs and symptoms of high blood sugar
- peeing (urinating) more than usual (polyuria)
- getting up in the night to urinate (nocturia)
- bedwetting (enuresis)
- thirst (polydipsia)
- poor energy level, tiredness, and irritability that doesn’t get better with food
- blurred vision
- weight loss
If you do not treat high blood sugar when ketones are present, it can lead to diabetic ketoacidosis (DKA). This is a life-threatening condition. For more information, please read the page on DKA in this section.
Signs and symptoms of diabetic ketoacidosis (DKA)
- high blood sugar levels and ketones in the urine
- excessive thirst
- urinating much more often and in larger amounts
- sudden loss of weight
- complaints of stomach pains or nausea
- vomiting
- leg cramps
- a flushed appearance
- headache
- signs of dehydration: dry mouth and tongue, sore throat, dark circles under the eyes
- deep, heavy breathing
- fruity-smelling breath
- drowsiness leading in time to unconsciousness
If your child shows any of these signs, notify your child’s doctor right away. DKA must be treated in a hospital.
What if your child with diabetes is sick?
When children with diabetes get sick, their blood sugar often goes high and ketones may show in the urine. Illness is a stress to the body, and stress creates a demand for more insulin. So on a sick day the usual amount of insulin may not be enough. Monitoring may show high blood sugar, with or without ketones. At such times you may need to increase the insulin dose, even though the appetite may be poor, to prevent diabetic ketoacidosis (DKA).
For more information, please read the page on Diabetes and Sick Days in this section. Special considerations for children using an insulin pump are discussed on the page on Sick Days and Insulin Pumps.