CLINICAL GUIDELINESWORK AT STARSHIPCONTACTS
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8. Severe hypoglycaemia

Severe hypoglycaemia is rare in tamariki/child with diabetes who are regularly monitored and supervised. With the use of continuous glucose monitoring (CGM), which can detect and alert low glucose levels earlier - it has become even less common. But changes to usual routines, activity, or insulin can increase the risk. Your tamariki/child can have glucose levels mostly within the target range of 4 to 8 mmol/L without risking severe hypoglycaemia.

What causes severe hypoglycaemia?

Severe hypoglycaemia usually happens when several things come together:

  • Not eating enough carbohydrate (refusing food or being sick)

  • Delayed or missed meals

  • Too much insulin

  • More exercise or activity than usual

  • Alcohol - see transition resources for young people

If mild lows are not treated quickly, blood glucose can fall very low and tamariki/child may become unconscious or pass out.

Periods of frequent low glucose (under 4 mmol/L) increase the risk of severe hypos. This can happen when routines are disrupted, for example:

  • Holidays and Birthday parties (especially when swimming or in hot pools)

  • Travel with time changes

  • Starting a new sport without adjusting insulin or food

  • Being sick

During these times, check glucose more often. If lows are persistent on CGMS or you are not sure if CGMS is accurate do a fingerpick test to confirm. Your diabetes team can help make a plan for changes in routine.

Symptoms of severe hypoglycaemia

  • Very drowsy or confused

  • Unconscious or passed out

  • Seizures or fit

What to do if your tamariki has had a severe hypo or is unconscious

  1. Place your tamariki/child on their side (recovery position) to protect their airway. Move away anything dangerous.

  2. Do not put anything in their mouth (food, drink, or glucose gel).

  3. Check blood glucose immediately. If <4 mmol/L, treat as severe hypoglycaemia. If you cannot test, treat as severe low.

  4. If blood glucose is >4 mmol/L, consider other causes (e.g., head injury).

  5. Call an ambulance, say your tamariki/child is unconscious and has Type 1 diabetes. Give the blood glucose level if you know it.

Glucagon injection

Glucagon raises blood glucose by turning stored sugar in the liver into glucose.

Using the Glucagon Kit (IM Injection)

  1. The kit has a syringe with sterile water and a vial of glucagon powder.

  2. Remove cap, inject all water into the vial, and swirl gently.

  3. Turn vial upside down and pull the mixture back into the syringe.
    • Tamariki/child under 5 years or <25 kg: give 0.5 mL
    • Tamariki/child over 5 years or >25 kg: give full dose

  4. Inject at a 90-degree angle (straight) into the large thigh muscle.

You can read a transcript of this video here.

After giving Glucagon

  • It takes 5–10 minutes for glucagon to work; your tamariki/child should start waking up.

  • Check blood glucose when awake.

  • When your tamariki/child can swallow, give fast-acting carbohydrate (0.3 g/kg) and recheck in 10–15 minutes. Repeat until blood glucose is >5 mmol/L.

  • Then give long-acting carbohydrate (toast or crackers).

  • If vomiting, offer sips of sweet fluids and check glucose every 15 minutes.

  • Contact the diabetes team at 09 631 0790 option 1. If your child is not brought to hospital, Insulin doses may need adjusting, and follow-up may be required.

  • Replace glucagon kit via GP or diabetes team.

  • Hospital is usually not needed if glucagon works well.

Additional considerations for managing severe hypoglycaemia on an Automated Insulin Pump (AID) System

  1. Suspend insulin delivery (no longer than 2hrs). Glucose may rise after glucagon; the pump may auto correct for this initial rise. Ensure your tamariki is fully recovered before restarting.

  2. Consider a minus profile /exercise mode (Tandem) or Ease-off/increased target (YpsoPump) for up to 24hrs afterward. Aim for glucose levels of between 8-10mmols/L for the next 24hrs then return to normal profile/rates.

Prevention of severe hypoglycaemia

  • Check glucose often and supervise closely.

  • Plan ahead for changes in routines (holidays, camps, trips).

  • Talk with your diabetes team about adjusting insulin if activity is higher or different.

  • For travel, ask the diabetes team; insulin doses and timing may need adjusting. Don’t forget to change pump time when you arrive at your destination.

  • CGMs may detect lows before symptoms occur. However, if you have concerns that your tamariki/child consistently does not feel any hypo symptoms, even in the lower ranges, please discuss these concerns with your specialist team.