Diabetes and Problem Solving

Important information about low blood sugars:

What is a low blood sugar?

  • It is a number below the ideal range.

  • In the weeks following diagnosis, your child may have more lows than highs.

  • A low is any number less than 70.

Why are low blood sugars dangerous?

  • Untreated low blood sugars can result in seizures, coma or even death.

  • A blood sugar less than 50 is dangerous if not treated.

What are other names for a low blood sugar?

  • Low blood glucose

  • Insulin reaction

  • Feeling shaky

  • Lows

  • Hypoglycemia

  • Insulin shock

What are signs of a low blood sugar?

  • Shaking

  • Sweating

  • Anxious

  • Dizziness

  • Fast heartbeat

  • Weakness or fatigue

  • Headache

  • Hunger

  • Irritable or crying

  • Confused

  • Impaired vision

Remember that young children cannot tell you how they are feeling.

If they are pale, cranky, very irritable, and tired, they may have a low blood sugar.

What causes a low blood sugar?

  • Not eating enough carbs at meals and snacks for the insulin given.

  • More activity than usual.

  • Not counting carbs correctly.

  • Too much insulin (error, or need for dose adjustment).

Who needs to know signs of low blood sugar and how to treat a low blood sugar?

Everyone who takes care of your child needs to know.

  • Babysitters

  • Coaches

  • Family members

  • Teachers

  • Bus drivers

  • Best friends

Why does my child sometimes feel low, but when I check, blood sugars are in range?

  • Symptoms can happen if the blood sugar is dropping quickly.

  • Do not treat.

  • Recheck the blood sugar every 15 minutes if symptoms continue.

  • Monitor the blood sugar until symptoms are gone.

  • If the blood sugar drops below 70, follow the rules for treating a low blood sugar.

Patient instructions for treating low blood sugars:

  • Give 15 grams of a quick acting carb (Quick acting means the food only has sugar in it. for example: 4 ounces of juice, 3 to 4 glucose tablets, 8 ounces of sports drink)

  • Recheck blood sugar in 15 minutes

  • Blood sugar should be higher than 70

  • If not, give another 15 grams of a quick acting carb

  • Recheck blood sugar in 15 minutes

  • Blood sugar should be over 70

If it is mealtime, do not give insulin until blood sugar returns to ideal range.

Call the Diabetes Center if the blood sugar does not come up after two treatments of quick acting carbs. .

How do I treat a low blood sugar if my child cannot drink or eat?

If your child is unresponsive or will not wake up:

  • You will have a medicine called glucagon to administer.

  • Glucagon takes 10 minutes to work and lasts for 60 minutes.

  • A nurse will show you how to use your glucagon. You can also refer to manufacturer guidelines as there are different preparations.

  • If glucagon is not available: Rub cake icing (decorative gel) or glucose gel inside the cheek and gums.

    • Call 911 if your child does not wake up in 10 minutes.

    • Call 911 if your child cannot eat/drink carbs after they wake up.

    • Let your diabetes provider know whenever you have used cake icing, glucose gel or glucagon to treat a low blood sugar.

Prevent and treat low blood sugars.

  • Know your child's signs of a low blood sugar.

  • Check if your child is having symptoms of a low blood sugar.

  • Always carry quick acting carbs for your child.

    • 4 ounces of juice

    • 3 to 4 glucose tablets

    • 8 ounces of sports drink

  • Treating with more than 15 grams at a time will cause a high blood sugar later.

Instructions for managing high blood sugars:

  • Hi blood sugar is a number above the ideal range.

  • High blood sugars are not a problem unless there are ketones in the urine.

When is a high blood sugar dangerous?

  • High blood sugars with ketones in the urine can be dangerous.

  • A lot of high blood sugars over a long period of time can lead to complications later in life.

What are other names for a high blood sugar?

  • Hyperglycemia

  • Highs

  • High blood glucose

What are signs of a high blood sugar?

  • Very thirsty

  • Frequent urination

  • Dry skin

  • Blurry vision

  • Confusion

  • Headaches

  • Stomach discomfort

  • Irritability

  • Feeling tired

Remember that young children cannot tell you how they are feeling. If you are concerned, check their blood sugar.

What causes a high blood sugar?

  • Eating too many carbs at meals and snacks for insulin dose given.

  • Less activity than usual.

  • Not enough insulin (error, or need for dose adjustment).

  • Not counting carbs correctly.

Instructions to treat high blood sugar:

If blood sugar is over 300 or higher for more than 3 hours:

  • Check for ketones.

  • If there are ketones that are moderate or large, call the Diabetes Center.

If above ideal range and there are no ketones in the urine:

  • Encourage your child to drink sugar-free fluids.

  • Encourage your child to exercise.

  • You can give a correction dose if it has been 3 hours since the last dose.

What are ketones?

  • Ketones are strong acids that come from fat breakdown.

  • Fat breaks down when there is not enough insulin.

  • Ketones make the body sick.

What causes ketones?

  • Your child is sick or getting sick.

    • If your child can't eat when sick, fat breaks down, causing ketones.

    • The body's stress response causes high sugars and ketones.

  • Not enough insulin.

  • Missed or skipped insulin injections.

  • Using expired or bad insulin.

  • Insulin pump site is kinked or failed.

  • Taking medications that make your insulin work less effectively such as prednisone, prednisolone, or dexamethasone. You should be in touch with the diabetes team if you are prescribed these medications. 

What are signs of ketones?

  • Stomach pain

  • Nausea

  • Vomiting

  • Extreme thirst

  • Fruity odor on breath

  • Trouble breathing

What is DKA (diabetic ketoacidosis)?

  • When ketones are not treated, the acids build up, causing DKA.

  • This is a serious and dangerous condition.

  • Your child will dehydrate and become very sick.

  • You can prevent DKA with immediate attention to ketones.

  • This is a serious and dangerous condition that requires hospital care.

What do I do if my child has moderate or large ketones?

  • Call the Diabetes Center immediately. The treatments for clearing ketones are insulin and hydration. The diabetes provider will walk you through these steps to treat the ketones.

What do I do if my child has trace or small ketones?

  • Do not forget to give bolus insulin for the high blood sugar if it is time.

  • Monitor blood sugar and check ketones again if blood sugar remains above 300 for more than 3 hours.

  • If ketones go from trace or small to moderate or large; call the emergency number for additional advice.

Instructions for caring for your child during illness:

What happens to my child's blood sugar when they are sick?

  • Vomiting, diarrhea and poor appetite may cause blood sugars to go down.

  • Infections and fevers may cause blood sugars to go up.

    The stress of illness may cause blood sugars to go up.

 What should I do if my child is vomiting or not able to eat?

  • Call the Diabetes Center.

  • Do not give any insulin until you talk to someone in the Diabetes Center.

  • Try giving teaspoons of sugar fluids every 10 minutes. Such as regular soda or juice.

  • Check the blood sugar and ketones every 2 hours.

When do I call the Diabetes Center or emergency number right away?

Every time that your child has:

  • Ketones that are moderate or large

  • Nausea

  • Vomiting

  • Abdominal pain

  • Trouble breathing

  • Lows that will not come up to ideal range.

Before you call, please know:

  • Your child's insulin and doses

  • The most recent blood sugar

  • Results of the ketone test

When should I call my child's primary healthcare provider versus calling the Diabetes Center?

  • Continue to call your child's primary healthcare provider for all sickness as you did before.

  • Call your child's primary healthcare provider for physicals and immunizations.

  • Call the Diabetes Center for help with blood sugars and ketones.

Can I give my child prescription or over-the-counter medicines?

  • Yes. You can give any medicine your healthcare provider prescribes for your child.

  • Over-the-counter medicine will not be harmful to your child with diabetes. It does not need to be sugar free.

 

Reviewed July 2025 by Kathryn Clawges MS, RD, CDCES, CPT