Hypoglycemia: Low Blood Sugar (Insulin Reaction)

Warning signs and symptoms of low blood sugar (insulin reaction) happen suddenly. Signs and symptoms can easily be mistaken for misbehavior. The child may not recognize symptoms developing. Severity of a low blood sugar reaction progresses from mild to severe. Severe reactions are preventable by early detection and treatment of low blood sugars. Be familiar with identification and treatment of low blood sugar to avert an emergency situation. Blood sugar can go to low if the child with diabetes has:

  • taken too much insulin
  • not eaten enough food
  • had extra exercise without extra food
Mild Hypoglycemia
Signs and Symptoms Treatment
  • Behavioral Signs: A wide variety of behaviors can occur.
  • Behavior changes may include:
    • acting quiet and withdrawn
    • being stubborn or restless
    • tantrums of sudden rage
    • confusion
    • inappropriate emotional responses (eg: laughter, crying)
    • poor concentration or day dreaming
  • Shakiness
  • Sweatiness
  • Headache
  • Dizziness
  • Pallor
  • Increased Heart Rate

NOTE: It may take the child several hours to recover following a low blood sugar episode. The student should not be expected to perform at optimal levels, but having diabetes should never be an excuse for poor overall school

  • If you don’t know what the blood sugar is, treat the symptoms.
  • Never send a child who you suspect is having a low blood sugar to the nurse’s office. Send another student to get help if you need it.
  • Give the child some quick-acting sugar such as:
    • 3 – 4 ounces of juice
    • 6 – 8 ounces of REGULAR pop
    • 2 – 4 glucose tablets
    • 5 – 6 lifesavers
    • 6 – 8 ounces Milk
  • Check the blood sugar 20 -30 minutes after treatment. If the blood sugar result is less than 80, or if the child still has symptoms, repeat the quick sugar treatment and blood sugar testing cycle until the child is symptom free and the blood sugar result is above 80.
  • When the child feels better and the blood sugar result is above 80, give One (1) of the following if the child’s next meal is more than 1 hour away and/or if the child will be participating in active play/ sports following this low blood sugar episode.
    • 1/2 sandwich
    • 1/2 cup milk
    • 4 graham cracker squares with peanut butter or cheese
    • 6 saltine crackers with peanut butter or cheese
  • The child may return to class after the blood sugar is above 80 and the child is symptom free.
Moderate Hypoglycemia
Signs and Symptoms Treatment
  • staggering walk
  • pale appearance
  • uncontrollable crying episode
  • slurred speech
  • blank stare
  • refusal to take anything by mouth
  • Follow the same procedure as indicated in the treatment for Mild Hypoglycemia with the following exception:
    • If the child has difficulty drinking but is able to swallow, (child may become irrational and uncooperative and may not be able to follow directions) slowly cake icing (gel type) or glucose gel inbetween the child’s cheeks – even if the child resists. This may require assistance.
    • Rub the cheeks gently to make sure sugar is being absorbed.
  • Follow with food if more than 30 minutes until next meal or snack (see mild hypoglycemia).
  • The child may return to class after the blood sugar is with above 80 and when the child is symptom is free.
Severe Hypoglycemia
This is a Medical Emergency!
Signs and Symptoms Treatment
  • unconscious
  • unresponsive
  • convulsion-like movement
  • failure to respond to cake icing (gel type) or glucose gel
  • Be sure child is lying down in a safe area protected from head and bodily injury.
  • Position the child on his/her side
  • Inject glucagon and/or call for emergency medical assistance (911 in the United States)
  • Do not attempt to put anything between the teeth
  • As the child regains consciousness, nausea and vomiting may occur
  • Notify parents/guardians and or diabetes team of the episode as soon as possible
Hyperglycemia: High Blood Sugar
Signs and Symptoms Treatment
  • loss of appetite
  • increased thirst
  • frequent urination
  • tiredness, sleepiness
  • loss of appetite
  • inattentiveness
  • rapid breathing
  • fruity odor to the breath
  • If the student has warning signs of high blood sugar, check the blood sugar.
  • If blood sugar is over 240, check urine ketones.
  • Negative to small: give lots of fluids (sugarfree such as water or diet pop)
  • Moderate to large: call parent/diabetes team (an order for extra short acting insulin may be given.
  • If the blood sugar test result in school is over 250, or if the student has warning signs of high blood sugar, parent/guardians need to be made aware. This does not have to occur immediately unless the student is spilling moderately large ketones.