What is the recommended dose of glucose tablets for a child with hypoglycemia (low blood sugar)?

Glucose Tablet Dosing for Pediatric Hypoglycemia

For a child with hypoglycemia, administer 10-15 grams of glucose tablets based on age and weight, with younger/smaller children receiving 10 grams and older/larger children receiving 15 grams. 1

Weight-Based Dosing Algorithm

The most precise approach uses 0.3 g of carbohydrate per kilogram of body weight, which has been validated in clinical trials to effectively resolve hypoglycemia in most children within 15 minutes. 2

For practical application:

• Younger children (typically <40 kg): 10 grams of glucose 1
• Older children and adolescents: 15 grams of glucose 1
• Alternative calculation: 0.3 g/kg for individualized dosing 2

Treatment Protocol

Initial Treatment

• Administer glucose tablets immediately when blood glucose is <70 mg/dL (3.9 mmol/L) 1, 3
• Recheck blood glucose in 10-15 minutes after treatment 1
• If hypoglycemia persists (<70 mg/dL), repeat the same dose 1

Expected Response

• Blood glucose should rise approximately 50 mg/dL with 15 grams of glucose 1
• Symptom resolution typically occurs within 12-15 minutes (median 12 minutes, range 8-15 minutes) 2
• Full normalization of blood glucose often requires the full 15 minutes 2

Glucose Tablets vs. Alternative Treatments

Glucose tablets are superior to dietary sugars for treating pediatric hypoglycemia. 1

Comparative Effectiveness (15-minute resolution rates):

• Glucose tablets: 87.0% 1
• Sucrose (Skittles): 84.7% 1
• Sugar mints (Mentos): 91.7% 1
• Orange juice: 70.0% 1
• Fructose (fruit leather): 67.3% - significantly less effective 1, 4
• Jellybeans: 73.3% - slowest response, often requiring repeat treatment 1, 2

The evidence consistently shows that fructose-containing products and jellybeans should be avoided as they produce significantly slower and less reliable glucose responses. 2, 4

Critical Safety Considerations

When to Activate Emergency Services

Call 911/EMS immediately if: 1

• Child is unable to swallow or unconscious 1
• Seizure occurs 1
• No improvement within 10 minutes of glucose administration 1
• Blood glucose remains <50-60 mg/dL despite treatment 1

Severe Hypoglycemia Management

For children who cannot swallow safely:

• Glucagon 0.03 mg/kg subcutaneously (maximum 1 mg) will raise blood glucose within 5-15 minutes 1
• Lower doses (10 mcg/kg) cause less nausea while maintaining efficacy 1
• Never administer oral glucose to unconscious or unable-to-swallow patients 1

Alternative for Uncooperative Young Children

For awake children who refuse to swallow glucose tablets, it may be reasonable to apply a slurry of granulated sugar and water under the tongue (buccal administration), though this is less effective than swallowed glucose. 1

Common Pitfalls to Avoid

• Do not use orange juice or fructose-based products as first-line treatment—they are significantly less effective than glucose tablets 1, 2, 4
• Do not rely on bedtime glucose readings to predict nocturnal hypoglycemia, as they are poor predictors 1, 5
• Do not undertreated based on initial response—blood glucose may only be temporarily corrected and require repeat dosing 3
• Do not give glucose gel as it produces minimal glucose increment at 10 minutes compared to tablets 6
• Avoid jellybeans despite their appeal to children—they require more frequent repeat treatment 2

Follow-Up After Treatment

• Provide a protein-containing snack after initial glucose treatment to prevent recurrence 1
• Monitor for delayed hypoglycemia, especially after exercise, which can occur hours later 1
• Consider reducing insulin doses by 10-20% if hypoglycemia is recurrent 5
• Assess for hypoglycemia unawareness in children with repeated episodes, as this indicates defective counterregulation requiring more frequent monitoring 1, 5