Hypoglycemia

We understand that you may have a lot of questions when your child is diagnosed with hypoglycemia:

• What is it?
• Will my child need to be hospitalized?
• How will it affect my child long-term?

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and options fully.

What is hypoglycemia?

Hypoglycemia is the state of having a blood glucose (also known as blood sugar) level that is too low to effectively fuel the body's cells.

What is glucose?

Glucose is a sugar that’s derived from the breakdown of carbohydrates found in foods, and the main source of fuel for the body (including the brain). It may be stored in the liver and muscles for later use, but excess glucose is converted to fat. The level of glucose in the blood is regulated by complex hormonal and neurologic mechanisms.

What is a healthy range of blood glucose?

The normal range of blood glucose throughout the day and night is approximately 70 to 150 mg/dl (milligrams of glucose per deciliter of blood). However, this varies according to a number of factors; your child’s doctor will talk with you about what should be a normal range for him.

Why is hypoglycemia a concern?

The brain depends on glucose, and too little can impair its ability to function. Severe or prolonged hypoglycemia could result in seizures and serious brain injury.

Causes

The vast majority of episodes of hypoglycemia in children and adolescents occur when a child with diabetes takes too much insulin and/or eats too little or exercises strenuously or for a prolonged period of time.

For young children who do not have diabetes, hypoglycemia may be caused by:

Single episodes:

• Stomach flu, or another illness that may cause them to not eat enough
• fasting for a prolonged period of time
• prolonged strenuous exercise and lack of food

Recurrent episodes:

• accelerated starvation, also known as “ketotic hypoglycemia”
• medications your child may be taking
•  a congenital (present at birth) error in metabolism or unusual disorder such as hypopituitarism or hyperinsulinism.

Other causes of hypoglycemia in children are rare.

What is accelerated starvation?

While accelerated starvation has a serious-sounding name, it simply refers to a tendency for children without diabetes or any other known cause of hypoglycemia to experience repeated hypoglycemic episodes.

Accelerated starvation usually first appears when a child is between 18 months and 5 years old. Children with accelerated starvation are more likely than others to experience hypoglycemia during illness, after having fasted (overnight, for example) and after strenuous exercise. They may be small and thin for their age, and have less muscle mass than their peers.

Treatment for accelerated starvation is simply making sure that your child avoids prolonged periods of fasting. Give him frequent, small meals and snacks, especially before bedtime and whenever the child has not eaten a heart supper. The condition usually disappears on its own by the time the child is 8 or 9 years old.

Symptoms

While each child may experience symptoms of hypoglycemia differently, the most common include:

• shakiness
• dizziness
• sweating
• hunger
• headache
• irritability
• pale skin color
• sudden moodiness or behavior changes, such as crying for no apparent reason
• clumsy or jerky movements
• difficulty paying attention, or confusion
• tingling sensations around the mouth

FAQ

Q: Will my child be okay?

A: Most likely yes. Hypoglycemia is serious, but usually not life-threatening.

Q: How could hypoglycemia affect my child’s health?

A: The brain depends on glucose, and too little can impair its ability to function. Severe or prolonged hypoglycemia could result in seizures and permanent brain injury.

Q: What causes hypoglycemia?

A: Most episodes of hypoglycemia in children and adolescents occur when a child with diabetes takes too much insulin and/or eats too little.

For children who do not have diabetes, hypoglycemia may be caused by:

Single episodes:

• stomach flu, or another illness that may cause them to not eat enough
• fasting for a prolonged period of time
• prolonged strenuous exercise and lack of food

Recurrent episodes:

• accelerated starvation, also known as “ketotic hypoglycemia”
• medications your child may be taking
• a congenital (present at birth) error in metabolism or unusual disorder such as hypopituitarism or hyperinsulinism.

Q: How long will it take my child to recover from hypoglycemia?

A: This depends entirely on the severity of the episode. If your child’s hypoglycemia is not severe, he should feel better within 10 to 15 minutes of eating or drinking something.

Q: Can hypoglycemia be prevented?

A: This depends on the cause, but many episodes of hypoglycemia can be prevented by making sure your child eats frequent meals and snacks throughout the day and has something to eat before going to bed. If your child eats little at dinner, a hearty snack before bedtime (such as a glass of milk and peanut butter on toast) will keep his blood sugar levels stable throughout the night.

Questions to ask your doctor

If your child is diagnosed with hypoglycemia, you probably have a lot of questions. Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

• What caused my child’s hypoglycemia?
• Will he have another episode?
• What can I do to prevent future episodes?
• What signs of an emergency should I watch for, and whom should I contact if I see them?

Hypoglycemia in the infant

Hypoglycemia is most common in newborns, especially in infants who are premature or small for their gestational age. To understand this condition, it’s helpful to start with a brief overview:

• In the womb, your baby receives nutrition (glucose and other nutrients) through the umbilical cord. His body uses some of it to grow, and stores the rest in his liver (in a form called glycogen).
• Once he is born and the umbilical cord is cut, his glucose level rapidly falls since he’s no longer receiving glucose from his mother.
• When his glucose level falls, it triggers the release of hormones that tell his liver to begin breaking down the glycogen it has stored up, so that his cells can use the glucose.
• There’s usually enough stored glycogen to fuel your infant’s cells for eight to twelve hours. After that, his glucose supply is depleted, and his blood sugar levels are low. For most newborns, they return to normal within 3-4 hours of birth or as soon as the baby is fed (usually as soon as possible after birth).

What causes hypoglycemia in an infant?

An infant might have hypoglycemia if he:

• is born prematurely or is small for his gestational age
• Babies store glycogen during the third trimester of pregnancy, so those born prematurely are more likely to experience hypoglycemia simply because their bodies haven’t had as much time to build up reserves of it and their supply runs out more quickly.
• has a congenital metabolic or hormonal disorder

Your newborn may also be hypoglycemic if he is born with a disorder that interferes with his body’s ability to properly use glucose.

•  has a diabetic mother
• In the womb, the fetus was exposed to high levels of glucose from the mother, and produced increased amounts of insulin to keep up with the high levels. range. Sometimes after birth, the baby’s body still has too much insulin. In these cases, the insulin causes the glucose to enter the body’s cells too quickly, which depletes the amount available, lowering the blood sugar level.
• Other causes include the infant’s liver not working as it should, and medications the mother was taking during pregnancy that interfere with the normal regulation of blood sugar in the fetus or newborn.

Symptoms

Since many infants with hypoglycemia show no symptoms, if they’re thought to be at risk they will be routinely monitored for low blood sugar levels. This group of infants includes those who:

• are premature
• are large or small for their gestational age
• were born to mothers who had been taking certain medicines
• were born to diabetic mothers
• were born with serious medical conditions

If symptoms do appear, they often include:

• jitteriness, tremors
• lethargy
• low muscle tone
• blue-ish appearance of the skin
• rapid breathing
• poor suck
• hypothermia (lowered body temperature)
• slow heartbeat
• sleep apnea
• seizures

Treatment

Healthy babies are fed as soon as possible after birth. Treatment for infants with hypoglycemia may include:

• oral glucose solution
• oral feedings of breast milk or formula
• IV infusions of a glucose solution
• Other medications

We frequently and closely monitor your infant with hypoglycemia regardless of the cause or treatment.