In someone without diabetes, the body is able to balance the blood glucose (BG) level between 3.5 and 7mmol/L the majority of the time. In Type 1 diabetes, where insulin is injected either by pen or pump it is much harder to keep the BG between this narrow range.
In diabetes we define Hypoglycaemia (Hypo’s) as a BG level goes below 3.9mmol/L or with newer technologies such as Continuous Glucose Monitoring (CGM) Sensors and Automated Insulin Delivery systems glucose levels between 3.6 and 8 mmols/L are increasingly possible.
If your child is wearing a sensor which is reading in the target range but they feel Hypo a finger prick glucose check should be carried out.
Your child may experience some of these sensations as the body tries to correct the hypo:-
The effect of low BG levels on the brain means that it may then become:-
You may notice they seem more:-
Some children have hypos at night without it disturbing their sleep, so can be more difficult to detect.
If they have a number of hypos this can also affect awareness so identifying and preventing them is important. Bedtime glucose levels do not necessarily predict the glucose overnight so checks around 2-3am may be recommended by your diabetes team.
If your child has exercised in the afternoon or early evening hypos later in the evening or overnight (approx. 7-11 hours later) can be more likely so checking overnight can be helpful.
The amount of Hypo treatment needed will vary according to the insulin regime.
Below you can see the usual amounts of fast acting glucose required for children of different ages. This will raise BG level by about 3-4mmols.
Lift Glucose Shot:
Lift Glucose Tablets (1 tablet contains 4g):
Lucozade Energy Tablets (1 tablet contains 3g):
Dextrose Energy Tablets (1 tablet contains 3g):
Fruit Pastilles (1 sweet contains 3g):
Haribo Treat Size (1 bag contains 12g CHO):
This is because it contains fat which slows the absorption of glucose, and lactose which is a more slowly absorbed carbohydrate so your child will likely take longer to recover.
Fructose (fruit sugar) is absorbed slightly slower than glucose but not as slowly as lactose. It may be an option if apple or orange juice is more acceptable, and you find it works quickly enough.
This is a rare occurrence which can lead to loss of consciousness and/or seizure and requires assistance by another person to administer an intramuscular injection of Glucagon.
If you would like to refresh skills in how to do this at any time please contact the diabetes team. You can also watch the short video on how to administer this intramuscular injection.
As young children are less able to communicate their needs, they are slightly more at risk of a severe hypo however the incidence of this has fallen significantly over the last 20 years and optimal glycaemic control can reduce the risk of severe hypos, In addition AIDs have further reduced this risk.
How To Give An Injection Of Glucagon
The aim is to support CYP and families to feel confident recognising and treating hypos so that they have the least impact on everyday life.
Key points to consider:
Achieving target glucose levels of 4-10mmols/L over 70% or (16hours of each day) and before meals a narrower target of 4-8mmols/L is recommended to reduce the risk of acute and long-term complications of diabetes and minimises effects on learning, feelings and quality of life.
High glucose levels can make a person feel unwell in the short term (eg thirsty, less able to concentrate, irritable) and if this happens regularly can lead to a raised HbA1c.
Thinking about possible reasons for this happening, noticing patterns on your CGM or the Glooko or Medtronic Carelink data platforms and contacting the diabetes team to discuss can help to actively find solutions promptly.
Common reasons for high glucose (above 8 mmols/L) may be:
High Glucose Values:
Check:
Check Glucose 9-14mmol/L:
Check Glucose >14mmol/L, Blood Ketones >0.6mmol/L (positive):
Check Blood Ketones >0.6mmol/L (positive):
Check; Blood Ketones <0.6mmol/L (negative):
Retest/Recheck:
Action:
If glucose levels are above target, your meter/pump bolus calculator will automatically increase the dose of insulin needed to match both carbohydrates eaten and to bring the glucose level back down to target range.
Both terms are essentially the same thing and refers to how much insulin is still working from previous insulin injections, infusions or boluses. It is a safety feature to prevent over correction of high glucose levels. If you have IOB or AIT the calculator may reduce or eliminate a correction dose to avoid the insulin “stacking” (giving too much insulin too close together) which could lead to hypos. Having high glucose levels immediately after meals does not necessarily mean you need more insulin, as the insulin given may still be working to bring the glucose level down.
AIT or IOB in CYP is usually set at 2 to 3 hours as smaller boluses mean the majority of the bolus will be used in this time.