Case: Mengmeng, girl, 5 years old. Had type 1 diabetes for 1 year. Every morning and evening, her mother injected her with self-mixed short-acting+medium-acting insulin, and blood glucose monitoring was relatively infrequent. Mom noticed that Mengmeng sometimes had cold sweats, cried and was irritable in the early morning, saying that her whole body felt uncomfortable. At 4:00 a.m. one day, Mengmeng again became irritable, cried, and had cold sweats. Her mother rushed her to the emergency room and measured her blood glucose at 1.3 mmol/L. She was diagnosed with hypoglycemia. The diagnosis of hypoglycemia was made. The glucose infusion corrected the hypoglycemia. Cold sweat, crying, irritability and general feeling of discomfort are a manifestation of hypoglycemia Diabetes in children, especially type 1 diabetes, requires lifelong insulin therapy, and all those on insulin therapy should be alert to hypoglycemia. The clinical manifestations of hypoglycemia are various, usually appearing as sympathetic excitation symptoms, such as pallor, sweating, palpitation, trembling of limbs and hunger, etc. In severe cases, symptoms that damage the function of higher nerve centers may appear, manifesting as serious consequences such as personality change, mental disorder, blurred vision, hand and foot twitching, drowsiness and lethargy. And there are also some non-specific symptoms, such as general discomfort, headache, abdominal pain, nausea, numbness of the mouth and lips, and urine loss. Moe’s cold sweat, irritable crying and discomfort in the early morning are the special manifestations of hypoglycemia. Causes of hypoglycemia Hypoglycemia in insulin therapy is mainly caused by the incongruity between diet, physical activity and insulin dose. The main reasons are: 1, the dose is too large, especially the injection of self-mixed insulin, often prone to the wrong extraction dose and different peak times related to the role of various dosage forms, such as the injection of short-acting + medium-acting mixed insulin before dinner, where the peak of medium-acting insulin after injection in 6-12h, which happens to be at the trough of insulin needs at night, and hypoglycemia is most likely to occur in the early morning hours. 2, injection site insulin absorption changes. When parents inject children, the tip of the needle may be too deep and mistakenly pierce into capillaries or muscle tissue, causing too rapid absorption of insulin. Children’s injection site area is small, and repeated daily injections are prone to hard lumps or subcutaneous tissue atrophy, which affects insulin absorption, while replacement of the site will prompt the rise and fall of blood glucose uncoordinated with eating, which also easily causes hypoglycemia. 3, children eat at will, playful, poor self-restraint, eating time is not fixed, after the injection does not eat or eat late resulting in hypoglycemia. 4.Exercise can accelerate the absorption of insulin at the injection site and can promote the utilization of glucose by the surrounding muscle tissue, which is a common cause of hypoglycemia. 5. Type 1 diabetes with long duration of disease, the compensatory function of releasing glucagon and adrenaline is impaired when hypoglycemia occurs, and hypoglycemia is very likely to occur, and the fluctuation range of high and low blood glucose is large, which used to be called brittle or unstable diabetes. 6. Self-monitoring of blood glucose is not strict. Children are in the stage of growth and development, lively and active, with irregular diet, and need more frequent blood glucose monitoring. The danger of hypoglycemia and prevention The stability of human blood glucose is extremely important to maintain the function of the central nervous system. Because the central nervous system cannot synthesize nor produce glucose, while it needs to consume 100-150g of glucose daily. If the blood sugar is lower than 2.5mmol/L, the clinical syndrome of sympathetic excitation and central nervous damage can occur. Repeated hypoglycemia also tends to lead to memory loss and intellectual impairment, which can lead to permanent brain dysfunction or death in serious cases. When correcting hypoglycemia, eating a lot and mobilizing glucagon at the same time will inevitably lead to hyperglycemia, and such fluctuations are even more detrimental to controlling blood sugar and preventing complications. Therefore, we should prevent and treat hypoglycemia in the following aspects: 1. Strengthen the education on first aid prevention and treatment of hypoglycemia to diabetic children, their relatives and friends, and even teachers and classmates, so as to detect and treat them in time; 2. Children are in the stage of growth and development, and the balance between diet control and nutrition intake to ensure growth and development needs specific guidance from doctors, especially to ensure regular eating and avoid blood sugar fluctuations. In case of hypoglycemia at night, a small snack can be added before going to bed to effectively prevent hypoglycemia at night; 3.Monitor blood glucose before and after exercise, and adjust it at any time when encountering special conditions, and carry desserts and drinks with you for backup; 4.For those who are prone to hypoglycemia at night, it is advisable to monitor blood glucose before going to bed and at 1-3 o’clock at night, and adjust insulin dose in time. hypoglycemia, when you are clear, you can take sugary cakes and drinks or 15g of glucose orally and observe for 15 minutes; if you are in coma, you should immediately send to hospital for resuscitation, inject glucose sedately, and continuously monitor blood sugar until the condition is stable to avoid the continuous action of drugs in the body and repeated hypoglycemia; 6. Type 1 diabetic children with irregular diet and exercise and large blood sugar fluctuations are insulin pump therapy applicable, can reduce the occurrence of hypoglycemia and improve the quality of life of children with diabetes by reducing the change of injection site and the timely adjustment of basal rate and pre-meal amount.