Hypoglycemia (also known as an "insulin reaction," or just "low blood glucose") occurs when blood glucose goes too low. Hypoglycemia can be caused by many things: too much insulin, not enough food, too much exercise, eating late, or eating too little carbohydrate. In short, it happens when insulin and blood glucose are out of balance.

People without diabetes usually don't get hypoglycemia. Their body can tell when it has enough insulin and stops releasing it automatically. But people with diabetes have to figure out how much insulin their body will need. Once the insulin is injected, it keeps working until it's gone, even if the blood glucose goes too low.

Mild or moderate (average) hypoglycemia is pretty common for children and adults who take insulin. But it can be dangerous if it's not treated right away. Mild or moderate hypoglycemia can get dangerously low pretty quickly. Hypoglycemia that low could lead to a coma. So knowing about hypoglycemia is very important, not just for you and your parents, but for family, friends, teachers, and coaches.

Nighttime lows

Sometimes you might wake up in the middle of the night feeling kind of foggy, sweaty, or like your heart's beating a lot faster than normal. If this happens, check your blood glucose right away. You could be having a nighttime low.

If you are low, treat for hypoglycemia, tell your parents about it (they'll probably want you to wake them up), and remember to call your doctor the next day. Also, see if you can think of anything that might have caused the nighttime low. Did you eat less than usual at dinner? Were you more active than usual before bed? Do you usually eat a snack before bed, but forgot it the night of the low? Figuring out what caused the nighttime low will help you avoid having more in the future.

Parents get pretty nervous about nighttime lows, and with good reason. Because you're asleep and no one's around (unless you share a bedroom), it's easy for you to get dangerously low without anyone even realizing it. People slip into comas in the night because of nighttime lows. So, don't be surprised if you wake up in the middle of the night to find your mom or dad by the side of your bed checking your blood glucose. Lots of parents do this. They're worried you could be low, so they drag themselves out of bed at 3 a.m. to check your glucose.

It's easy to be annoyed by this at first. Particularly if you're older and doing a lot of your diabetes care on your own. Your first reaction might be, "Aw, Mom!" Try to remember that your parents just want you to be safe, and that if you did have a nighttime low, even you may not know it. So try to at least tolerate any parental nighttime checks.

If it really bugs you a lot, you might be able to strike a deal with your folks. Come up with a plan to keep them in bed, but still reassure them that you're safe. Maybe something like this: Tell them that you'll set YOUR alarm clock for 2 or 3 a.m. (whatever time they like), and you'll wake up and check your own blood glucose (keep a kit right by the side of your bed so you don't have to get up). If you're low, you'll treat appropriately, then go wake Mom or Dad to give them the results. They'll probably want you to come tell them the results whether you were low or not. And they may set THEIR alarm clock to come do a check if they don't hear from you by a certain time.

Signs and Symptoms of Hypoglycemia

Each person reacts to hypoglycemia differently. You may only have a few symptoms. It's important for you and your parents to observe what symptoms are unique to you. That way, you can recognize it sooner, and treat it before it becomes serious.

• Shakiness
  
• Nervousness
  
• Sweating
  
• Irritability, sadness, or anger
  
• Impatience
  
• Chills and cold sweats
  
• Fast heartbeat
  
• Light-headedness or dizziness
  
• Hunger
  
• Drowsiness
  
• Stubbornness or combativeness
  
• Lack of coordination
  
• Blurred vision
  
• Nausea
  
• Tingling or numbness of lips or tongue
  
• Nightmares or crying out during sleep
  
• Headaches
  
• Strange behavior
  
• Confusion
  
• Personality change
  
• Passing out

Treating Mild or Moderate Hypoglycemia

When you or your parents notice symptoms of hypoglycemia, it's important to treat it right away. If you're feeling a little "off" but not too bad, you or your parent should do a blood glucose check first. Your doctor or diabetes educator can tell you which blood glucose levels mean you have hypoglycemia. But if you feel fairly sick or don't have your meter, go ahead and treat for hypoglycemia. Here's how.

Step 1
Eat or drink something with 10 to 15 grams of carbohydrate.

Step 2
Wait 15 minutes, then check your blood glucose.

Step 3
If your blood glucose is still too low (or you don't feel better), take another dose of 10-15 grams of carbohydrate and check again after 15 minutes.

Step 4
Once your blood glucose begins returning to your normal range, eat a snack containing carbohydrate and protein. (Crackers with cheese or peanut butter is a good choice.)

If your blood glucose stays too low even after treatment, your parents may need to take you to a doctor or hospital.

Don't Go Overboard

Don't use hypoglycemia as an excuse to pig out on sweet stuff. You'll only have the opposite problem - high blood glucose - later in the day. Also, stick to sugary foods that don't have a lot of fat. Fat slows down the movement of sugar into your blood. So candy bars and cookies are not the best choices for treating hypoglycemia, unless they're the only high-carb foods nearby.

Preventing & treating severe hypoglycemia

If mild or moderate hypoglycemia isn't treated promptly, it can turn into severe hypoglycemia. People with severe hypoglycemia have so little glucose in their system that it affects their brain. When that happens, they pass out.

The best way to avoid severe hypoglycemia is catch it early. Be alert to any symptoms of hypoglycemia. Check your blood glucose if you have any doubt. Always carry some glucose tabs or other carbohydrate with you to treat hypoglycemia.

If you do develop severe hypoglycemia, you'll need help from the people around you. You can't drink soda or chew glucose tablets when you're unconscious. That's where glucagon comes in. Glucagon is a substance that makes the liver release sugar into your bloodstream. It can be injected to treat severe hypoglycemia. If no glucagon is available or no one knows how to inject it, you must be taken to the hospital right away. Ask your doctor for more information and a prescription for glucagon.

Don't forget to wear a medical ID bracelet or necklace that says you have diabetes and take insulin. You can't tell anyone about your diabetes if you're unconscious or confused, but the medical ID can. For more about medical IDs, click here. 

Your parents and your doctor can help you decide who to talk to about hypoglycemia and glucagon. Your parents can also help you teach your friends and teachers about your diabetes.

Hypoglycemia Busters (fast-acting carbs)

Keep something containing sugar with you at all times to treat hypoglycemia. Each of the following foods has the right amount of carbohydrates (10 to 15 grams) to treat hypoglycemia.

• 2 glucose tablets or 2 doses of glucose gel
  
• 2-4 pieces hard candy
  
• 1/2 to 3/4 cup of orange or grape juice (a juice box is good when you're away from home)
  
• 5 gumdrops
  
• 1-2 tablespoons of honey
  
• 6 oz. regular (not diet) soda (about half a can)
  
• 2 tablespoons of cake icing (the kind that comes in a tube is handy)