Is it normal for children as young as two years old to experience hypoglycemia (blood sugar under 50 milligrams per deciliter (mg/dL)) and hyperglycemia (blood sugar above 200 mg/dL)?

From the Guidelines

No, it is not normal for children as young as two years old to have blood sugar levels under 50 mg/dL or above 200 mg/dL. These values are outside the normal range and could indicate a serious medical condition that requires immediate attention. For healthy toddlers, normal blood glucose levels typically range from 70-140 mg/dL when fasting and may rise to around 180 mg/dL after meals, but should return to normal within 2-3 hours. Blood sugar below 70 mg/dL (hypoglycemia) can cause symptoms like irritability, confusion, shakiness, and in severe cases, seizures or loss of consciousness. Blood sugar consistently above 200 mg/dL (hyperglycemia) may indicate diabetes or other metabolic disorders.

Key Considerations

• According to the American Diabetes Association, as stated in 1, blood glucose monitoring is crucial in assessing for hypo- or hyperglycemia in young children, and these symptoms may be subtle, especially in young children.
• The association also recommends that A1C goals must be individualized and reassessed over time, with an A1C of <7% (53 mmol/mol) being appropriate for many children and adolescents, as mentioned in 1.
• Children with blood sugar levels under 50 mg/dL or above 200 mg/dL should seek immediate medical care, as these extreme blood sugar values could indicate type 1 diabetes, congenital hyperinsulinism, or other endocrine disorders that require proper diagnosis and management by a pediatric endocrinologist.

Management and Monitoring

• The pediatrician may order additional tests, including hemoglobin A1C, insulin levels, or antibody tests to determine the cause of the blood sugar fluctuations.
• Continuous glucose monitoring metrics, such as time in range (70–180 mg/dL), time below target (<70 and <54 mg/dL), and time above target (>180 and >250 mg/dL), can be used to achieve a lower A1C and reduce the risk of hypoglycemia, as discussed in 1.
• Meticulous use of therapeutic modalities, such as rapid- and long-acting insulin analogs, technological advances (e.g., CGM, sensor-augmented pump therapy, and automated insulin delivery systems), and intensive self-management education, can help achieve glycemic goals while reducing the incidence of severe hypoglycemia, as mentioned in 1.

From the Research

Blood Sugar Levels in Children

• There are no research papers to assist in answering this question about blood sugar levels in children as young as two years old having blood sugars under 50 and above 200, based on the provided evidence 2.
• The study 2 focuses on the growth and conidiogenesis of Arthroderma (trichophyton) simii Stockdale, which is unrelated to blood sugar levels in children.
• The provided study 2 discusses the influence of temperature, pH, and glucidic substrates on the growth of a specific fungus, and does not provide any information about human physiology or pediatric health.