Hypoglycemia is low blood sugar, usually under 70 mg/dL, and it is the most common emergency in children with type 1 diabetes. At school it can follow extra exercise, a missed snack or too much insulin, and quick treatment prevents seizures.
Key symptoms
- Shaky, sweaty, pale or hungry
- Headache, irritability or crying
- Poor focus or acting confused
- Sleepiness, slurred speech or clumsiness
- Seizure or unconsciousness when severe
What you find on exam
- Level of consciousness and ability to swallow safely
- Bedside glucose with a glucometer
- Heart rate, breathing and skin color
- Check the insulin pump or recent insulin dose and food intake
Tests
- Fingerstick glucose right away; treat first if no meter is available
- Repeat glucose 15 minutes after treatment
- Ketones if glucose later swings high or the child is unwell
Treatment basics
- Awake and able to swallow: 15 g of fast sugar, such as juice or glucose tablets
- Recheck in 15 minutes and repeat if still under 70 mg/dL
- Then a snack with carbohydrate and protein if the next meal is far away
- Unconscious or seizing: glucagon by nasal spray or injection, place on the side, call 911
- Inform parents and review the school diabetes care plan
Red flags
- Unconscious, seizing or unable to swallow
- No improvement after two rounds of treatment
- Repeated lows on the same day
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); Open RN, Nursing Pharmacology 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.