Q: Our son was recently diagnosed with type 1 diabetes. I’m learning how to manage his blood sugar, but I’m worried that if he ever develops a severe low, I’ll panic having to decide whether it’s serious enough for emergency treatment. How can I make sure I’m prepared to make the call?
Aristides K. Maniatis, M.D., F.A.A.P., double-board-certified in both pediatrics and pediatric endocrinology, is a pediatric endocrinologist with Rocky Mountain Pediatric Endocrinology in Centennial, Colorado.
Disclaimer: The information in this article is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
A: Learning to recognize and respond to a severe low (severe hypoglycemia) starts with a greater awareness of your child’s blood sugar patterns and how to respond to them.
At diagnosis, your diabetes care team gave you recommendations regarding how often to check your child’s blood sugar. Follow your care team’s guidelines. For example, we train parents to test their children’s blood sugar routinely (four to six times per day). If your child is sick or has been physically active or some other factor is present, you might need to test more frequently. Your child could also have a CGM (continuous glucose monitor) which helps bring even more awareness to blood sugar levels.
As you become more comfortable with your child’s care and how to respond to blood sugar readings, it becomes easier to recognize mild lows and treat them with fast-acting carbs, such as juice, glucose tabs, or candy. Over time, most parents become aware of the behavioral changes their child exhibits when they’re low and will check their blood sugar if they seem to be acting weird, and correct as needed.
Parents and caregivers should always be prepared to treat a mild low by having juice and other low supplies on hand. If you catch a low when it’s mild, you have a better chance to prevent a severe low.
Still, severe lows can happen, sometimes unexpectedly, and you will want to work with your care team to practice how to respond and make decisions in the moment should a severe low develop.
Signs of a severe low include unresponsiveness, unconsciousness, and seizures or convulsions. When any of these symptoms are present, parents can administer an emergency treatment for severe hypoglycemia. The treatment triggers the rapid breakdown of glycogen stored in the liver, which quickly raises blood sugars.
For their own comfort level in administering treatment for severe lows, parents should be aware that two forms of the treatment are now available: an intramuscular injection and a new intra-nasal powder. Talk to your diabetes care team about which treatment option is right for your child and go over the steps for how treatment is administered until you feel comfortable. To help boost your confidence “in the moment,” there are smartphone apps which may help with step-by-step directions on how to administer treatment.
Preparation is key for responding quickly to severe lows and for remaining calm. A severe hypoglycemic event is stressful enough without needing to worry if you have the right supplies or know how to use them. Make sure your child has access to a severe low kit at all times — generally, carrying one in their diabetes bag and keeping one at school will work. Parents should also make sure caregivers are trained in how to spot and respond to severe lows.
After treating a severe low blood sugar, contact your child’s diabetes care team to review what happened and how you responded. The incident may have taught you something new — like an unexpected situation that caused your child’s blood sugar to drop — so you can adjust your child’s management to prevent future lows.
Note: If you give your child a treatment for a severe low and your child’s blood sugar does not respond, call 911.
How Other Parents Deal
“I’m part of a support group for parents of children with type 1 diabetes, and a great tip I picked up was to catalogue all the places where your child frequents and stash low supplies there…just in case. When I did this, the ballet class my daughter attends once a week popped into my head. At first I thought it was a little overboard to ask to keep juice boxes in the closet and put up a sign about recognizing lows for someplace she’s only at for an hour max, but I still did it. I’m glad I did. One night, I needed to duck out to the post office. While I was gone, she went low. The kids got the teacher’s attention by pointing to the poster, and the teacher was able to get her a juice box. When I got back, she was still coming up from the low, but that little bit of prevention staved off what could have been a much worse situation.”
—Erica N., Fort Meyers, Florida, mom of 6-year-old Nicole
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.