Diabetes in children: signs of a hypo (hypoglycemic) reaction

DIABETES IN CHILDREN: SIGNS OF A HYPO (HYPOGLYCEMIC) REACTION

Early warning signs
At the stage when the level of glucose in the blood is falling rapidly, there will usually be warning signs before the level becomes too low. These include hunger, tremulousness, dizziness, headache, shaking, weakness or other odd feelings the child himself learns to recognize. At this stage the child may become pale and sweaty with a rapid pulse rate.
These warning signs are readily corrected by taking sugar.
There may possibly come a time - perhaps because the / warning signs were not recognized or heeded or because they were only present for a few moments, or in some cases they may not have been present at all - when blood glucose may fall to very low levels. When this occurs, it may mean that there is insufficient glucose for the efficient functioning of the brain, which depends on a constant supply of glucose from the blood.

Later signs
So the brain, deprived of sufficient glucose, may act in an unusual fashion and this leads to unusual behaviour of the child. He may become irritable, or cry easily, lose concentration and seem vague or be unreasonable or bad tempered. He may get a headache, or feel dizzy, 'funny' or drowsy. He may become weak in some muscles, or develop trembling of his limbs. He may even lose consciousness and some children may have a convulsion although this is very rare.

A hypo reaction may happen quickly
Usually these things develop quite rapidly and at a time when the child has been otherwise well. A normal or even a high blood glucose level earlier in the day does not rule out the possibility that a hypo may occur later, as the blood glucose level may fall quite rapidly from a high to a low level in a few hours.

When may a hypo reaction occur?
Although one child differs from another in his behaviour during a hypo, he tends to have the same sort of reaction each time he has one. Thus he or his parents quickly come to recognize a hypo when it is developing, and treatment can be given at once before more serious signs develop. Hypos tend to occur when sugar produced from a recent meal is largely used up and at its lowest level; often just before the next meal is due. Other times to be on the lookout for hypo reaction are after strenuous exercise or unusual activity. Each type of insulin has its time of maximum effect and at these times there is the most likelihood of an insulin reaction.

Difficulties in recognizing hypo reaction
There will be times in the early stages of your child's diabetes, and especially if he is a baby or toddler, when you may be uncertain whether unusual behaviour is due to a reaction or not. As you get more experienced, you will learn to recognize reactions quite easily, but if you are in any doubt it is better to regard the unusual behaviour as a reaction and treat it. Note whether there is an improvement after giving treatment; if so it was probably a hypo reaction and if not probably was not. Very occasionally some children 'put on' bad behaviour and complain of headache to get the extra sugar you will use to treat the supposed reaction. If you suspect this, do a blood test. A low test will tend to confirm the probability that it is a hypo reaction.
Some symptoms of a hypo - paleness, sweating, shakiness for example, are the result of the body's reaction when the glucose level in the blood is rapidly falling. This can occur when the glucose is falling from say 6 to 3 mmol/1, so there is a true hypo, but can also occur if, say, the blood glucose falls from 12 to 8 mmol/1. In this case, the child is heading for a hypo but is not actually hypoglycemic. This may explain why the blood test is not always low when symptoms occur.
It also helps to explain why sometimes a child's blood glucose level may be found to be low but there are no symptoms. In this case, perhaps the blood glucose has been falling slowly, so the body doesn't recognize the fall and there is no reaction.

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