Hypoglycemia Health Article

Definition

Hypoglycemia is a condition characterized by low blood sugar, or abnormally low levels of glucose in the blood.

Description

Hypoglycemia (also known as a hypo, insulin shock, and a low) is brought on by abnormally low levels of glucose in the blood (i.e., 70 mg/dl or less). The condition is common among children with type 1 diabetes, but may also occur less frequently in children or teens with type 2 diabetes who are taking a sulfonylurea drug. An inadequate diet, improperly calculated insulin dose, minor illnesses, or excessive activity without adequate sustenance can contribute to the condition. If unchecked, hypoglycemia can lead to unconsciousness. In very rare cases, the victim may suffer a seizure.

A hypoglycemic child will appear irritable, sweaty, shaky, and confused and may complain of being very hungry. In most cases, a snack of quick-acting carbohydrates (e.g., juice or hard candy) will remedy the situation. Glucose tablets or gel can also be taken. A child who has lost consciousness due to hypoglycemia may require a glucagon shot to return blood sugar levels to normal.

Newborns of women with gestational, type 1, or type 2 diabetes during pregnancy may also experience hypoglycemia at birth, particularly if the mother's blood glucose levels were not well controlled in late pregnancy. High levels of maternal glucose cause the fetus to generate equally high levels of insulin to handle the over-load, and when the maternal glucose source is disconnected at birth with the cutting of the umbilical cord, all of that insulin causes the newborn's blood sugar levels to plummet. Intravenous administration of a glucose solution to the newborn can help re-establish normal blood sugar levels.

A rare type of hypoglycemia, known as reactive hypoglycemia, may occur in children and teens without diabetes. In reactive hypoglycemia, blood glucose levels drop to 70 mg/dl approximately four hours after a meal is eaten, causing the same symptoms of low blood sugars that can occur in people with diabetes.

Also rare is fasting hypoglycemia, a condition in which blood sugars are 50 mg/dl or lower after an over-night fast or between meals. Certain medications and medical conditions can cause this problem in children who do not have diabetes.

Demographics

Among children with diabetes, hypoglycemia is much more common in those with type 1 diabetes (also known as insulin-dependent diabetes or juvenile diabetes) than in those with type 2 diabetes (formerly known as adult-onset diabetes).

Causes and symptoms

Hypoglycemia in children and teens with diabetes can be triggered by too much insulin, excessive exercise without proper food intake, certain oral medications, skipping meals, and drinking alcoholic beverages.

Symptoms of hypoglycemia include:

• shakiness
• nervousness
• irritability
• dizziness
• sweating
• confusion
• fatigue
• hunger
• feelings of anxiety

Reactive hypoglycemia can be triggered by enzyme disorders and by gastric bypass surgery. Causes of fasting hypoglycemia in children without diabetes may include insulin-producing tumors, certain hormonal deficiencies, medications (including sulfa drugs and large doses of aspirin), and critical illnesses. Fasting hypoglycemia is more likely to occur in children under the age of 10.

When to call the doctor

Children who are experiencing frequent episodes of hypoglycemia should see their diabetes care doctor as soon as possible as they may require an insulin adjustment, medication change, or another change in their treatment regimen.

If a child or teen with diabetes starts experiencing low blood sugars without any symptoms, he or she may be developing hypoglycemic unawareness and the child's physician should be notified immediately. In hypoglycemic unawareness, the body stops sending its normal warning signs of hypoglycemia, and a child may not realize that blood glucose levels are dangerously low until he or she loses consciousness.

Diagnosis

Episodes of hypoglycemia in children and adolescents with diabetes can be confirmed with a blood test on a home blood glucose monitor. A small needle or lancet is used to prick the finger or an alternate site and a small drop of blood is collected on a test strip that is inserted into the monitor. The monitor then calculates and displays the blood glucose reading on a screen. Although individual blood glucose targets should be determined by a medical professional in light of a child's medical history, the general goal is to keep them as close to normal (i.e., 90 to 130 mg/dl or 5 to 7.2 mmol/L before meals) as possible. Glucose levels that are below 70 mg/dl (3.9 mmol/L) are typically considered hypoglycemic.

In order to diagnose reactive hypoglycemia in those without diabetes, a blood sample must be drawn while a child is experiencing symptoms. If the blood glucose levels are 70 mg/dl or lower and the symptoms subside after food or drink is provided, reactive hypoglycemia is diagnosed.