A “diabetic emergency” requiring sugar refers specifically to hypoglycemia, a condition where a child’s blood glucose level drops too low. Hypoglycemia is a common, acute, and potentially dangerous complication in the management of childhood diabetes. This state occurs when there is an imbalance between the child’s insulin dose, food intake, and physical activity. Prompt and accurate intervention with fast-acting carbohydrates is necessary to prevent symptoms from progressing to severe complications like seizures or unconsciousness. Understanding the signs and the correct dosage is essential for parents and caregivers to manage this situation effectively.
Recognizing Hypoglycemia in Children
Before administering treatment, caregivers must confirm the child is experiencing low blood sugar, typically defined as a blood glucose reading below 70 mg/dL. Common early signs of hypoglycemia include shakiness, sweating, extreme hunger, pale skin, and a fast heartbeat. Older children may report headaches or blurred vision, while young children might exhibit sudden mood changes, such as irritability.
The most accurate way to confirm the reading is using a blood glucose meter, even if the child uses a continuous glucose monitor (CGM). If symptoms are present but testing is not immediately possible, it is safer to treat for low blood sugar rather than delaying intervention. Hypoglycemia must be distinguished from hyperglycemia (high blood sugar), which requires insulin and hydration, not sugar, to correct the imbalance.
Administering the Correct Sugar Dosage
The treatment for mild to moderate hypoglycemia in a conscious child follows the “Rule of 15s,” a cycle of consuming sugar, waiting, and retesting. The goal is to raise the blood sugar level above 70 mg/dL without causing an extreme high. For older children and adolescents, the standard dosage is 15 grams of simple carbohydrates. Very young children, such as infants and toddlers, require a smaller amount, typically 5 to 10 grams, to prevent overtreatment.
Fast-acting carbohydrates must be pure sugar sources that are easily absorbed, containing no fat or protein, which would delay the blood sugar rise. Effective sources providing approximately 15 grams of simple carbohydrate include:
- Four ounces of 100% fruit juice.
- Four ounces of regular soda (not diet).
- Three to four glucose tablets.
- One tablespoon of honey or granulated sugar dissolved in water.
- One tube of glucose gel.
After the initial dose is consumed, the child must wait 15 minutes before the blood glucose is re-checked. If the blood sugar remains below 70 mg/dL, the entire process is repeated by administering another dose of fast-acting carbohydrate. This cycle continues until the child’s blood glucose is safely above the target range.
When Immediate Medical Help is Necessary
Once blood glucose stabilizes above the target range, provide a follow-up snack to prevent a rapid return to hypoglycemia. This snack should contain complex carbohydrates and protein, such as crackers with peanut butter or cheese, or a glass of milk. This combination offers a slower, sustained release of glucose until the child’s next scheduled meal.
If the child is unconscious, seizing, or unable to safely swallow oral treatment, the situation is a severe hypoglycemic event. Oral sugar must not be given due to the risk of choking or aspiration. The emergency treatment involves administering Glucagon, a hormone that stimulates the liver to release stored glucose into the bloodstream.
Glucagon is available as an injectable solution or a nasal powder spray, and the specific dosage depends on the child’s age or weight. For children weighing less than 25 kilograms (about 55 pounds) or under six years old, a smaller dose of 0.5 mg is typically prescribed, while older or heavier children receive the full 1.0 mg dose. It is imperative to call for emergency medical help immediately after Glucagon has been administered, even if the child appears to be recovering, as the effects of the medication are temporary.
All caregivers should be trained in the use of the emergency Glucagon kit and have a clear, written emergency plan in place that is reviewed regularly with the child’s diabetes care team.