How should I treat a child or young person with type 1 diabetes who has a blood glucose below 3.9 mmol/L, including if they use a hybrid closed loop system according to ACDC?

If the child/young person is conscious and able to swallow:

• BG <3.9 mmol/L is the alert threshold and should prompt treatment straight away.
• If 3.0–3.8 mmol/L (ACDC “Level 1”): self-treat orally with fast-acting carbohydrate.
• If <3.0 mmol/L (ACDC “Level 2”): immediate treatment required; they may need help from an adult.
• Recheck capillary glucose after 15 minutes and repeat fast-acting carbohydrate if still <3.9 mmol/L.
• Once glucose is back >3.9 mmol/L, give longer-acting carbohydrate if a meal/snack is not due; do not omit insulin, especially if the hypo was before a meal. [1]

If they use a hybrid closed loop (HCL) system

ACDC advises that smaller oral carbohydrate doses may be needed because automated insulin delivery often reduces or suspends insulin before the low; half of the usual oral hypo treatment may be a good starting point, to avoid rebound hyperglycaemia. ACDC also advises rechecking on CGM 20–30 minutes later to confirm the glucose stays above target, while still using capillary glucose to confirm if needed. [1]

If they are drowsy, confused, unable to swallow, seizing or unconscious

Do not give oral carbohydrate. Treat as severe hypoglycaemia: give IM glucagon or IV 10% dextrose and obtain urgent medical help. [1][2]