Blood glucose, often called blood sugar, is the body’s main source of energy derived from the food a child eats. This sugar circulates in the bloodstream, delivering fuel to cells throughout the body, especially the brain. Monitoring these levels is important because a child’s body is constantly growing and requires consistent regulation. Blood sugar measurements are commonly expressed in two units: milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). These measurements establish targets that help ensure a child is developing appropriately.
Expected Glucose Levels for Non-Diabetic Children
A child without a diagnosed metabolic condition maintains blood sugar within a narrow and consistent range through the natural function of insulin and other hormones. These levels serve as the baseline for healthy regulation.
Before a child eats (fasting state), blood glucose concentration typically ranges from 70 to 100 mg/dL (3.9 to 5.5 mmol/L). This reflects the body’s steady production of glucose by the liver to sustain energy needs. After a meal, especially one containing carbohydrates, blood sugar naturally rises as glucose enters the bloodstream. A non-diabetic child’s blood glucose should peak and then return to the baseline quickly. Two hours after the start of a meal, the level should be less than 140 mg/dL (7.8 mmol/L).
Blood Sugar Targets for Children Managing Diabetes
For children managing diabetes, blood sugar targets are defined by healthcare providers to balance the risk of long-term complications with the immediate danger of low blood sugar. These personalized targets are based on a child’s age, developmental stage, and risk factors for severe hypoglycemia. The goal is to keep glucose concentrations within a safe range for the majority of the day.
A common metric used to gauge long-term control is the A1C test, which reflects the average blood sugar level over the preceding two to three months. Major pediatric endocrine organizations recommend an A1C goal of less than 7.0% or 7.5% for most children and adolescents. A less stringent target may be appropriate for a child who is very young or frequently struggles to recognize the symptoms of low blood sugar.
The daily targets focus on three main periods: pre-meal, post-meal, and overnight.
Pre-Meal and Fasting Targets
Pre-meal and fasting glucose levels are typically targeted to be between 90 and 130 mg/dL (5.0 and 7.2 mmol/L) for older children and adolescents. Younger children, particularly those under age six, often have a slightly higher target range, such as 100 to 180 mg/dL (5.5 to 10.0 mmol/L) before meals, to help mitigate the risk of hypoglycemia.
Overnight Targets
The overnight goal is important for safety, with a common target range of 90 to 150 mg/dL (5.0 to 8.3 mmol/L) for older children. Maintaining this level helps prevent dangerous overnight drops. Achieving these targets requires frequent monitoring and adjustments to insulin doses, diet, and activity levels.
Identifying and Treating Hypoglycemia
Hypoglycemia, or low blood sugar, occurs when the blood glucose concentration drops below 70 mg/dL (3.9 mmol/L) and requires immediate intervention. Since glucose fuels the brain, a significant drop can rapidly cause neurological symptoms.
Common indicators of hypoglycemia include:
- Shakiness, sweating, pallor, dizziness, and a rapid heartbeat.
- Behavioral changes like sudden irritability, confusion, or difficulty concentrating.
When a blood sugar reading is low, immediate action is necessary. The standard response is the 15-15 Rule:
The 15-15 Rule
This involves consuming 15 grams of a fast-acting carbohydrate, such as four ounces of juice or three to four glucose tablets, to rapidly raise the blood sugar.
After 15 minutes, re-check the blood glucose level. If the level is still below 70 mg/dL, the 15-gram treatment is repeated until the reading is stable. Once stable, a small snack containing carbohydrate and protein should be consumed if the next planned meal is more than an hour away.
Severe hypoglycemia (below 55 mg/dL or 3.0 mmol/L) can lead to loss of consciousness or seizures and is a medical emergency. If the child cannot safely swallow, emergency glucagon must be administered. Glucagon is a prescription hormone that signals the liver to release stored glucose. Following administration, emergency medical services should be called immediately, and the child should be positioned on their side to prevent choking.
Recognizing and Responding to Hyperglycemia
Hyperglycemia, or high blood sugar, occurs when the body has too much glucose circulating in the blood, typically defined as a reading over 180 mg/dL (10.0 mmol/L). It is often caused by insufficient insulin dosing, illness, or stress, which increases the body’s resistance to insulin. Common symptoms include frequent urination, excessive thirst, fatigue, and blurred vision.
If blood sugar remains high, the body may break down fat for energy, producing acidic byproducts called ketones. This can rapidly progress to Diabetic Ketoacidosis (DKA), a life-threatening complication requiring urgent medical care. DKA is defined by high blood glucose, significant ketones, and metabolic acidosis.
When blood glucose is persistently high or the child is ill, checking for ketones is necessary using urine strips or a blood meter. Symptoms of DKA include:
- Nausea, vomiting, and abdominal pain.
- Deep, rapid breathing (Kussmaul respirations).
- A fruity odor on the breath.
For routine high readings without moderate or high ketones, the response involves administering a correction dose of insulin, as directed by the care plan, and encouraging hydration. If a child has moderate to high ketone levels, is vomiting, or shows signs of confusion, immediate contact with a healthcare provider or a trip to the emergency room is necessary. These are signs of metabolic distress requiring urgent treatment to correct the dangerous acid build-up.