In the event of hypoglycemia in this patient, the parents should have a supply of oral glucose solution and IM glucagon. Hypoglycemia can occur quickly, and prompt management is indicated. Oral glucose is preferred for treatment but, if the patient becomes comatose or unresponsive, glucagon can be administered IM. Early signs of hypoglycemia include dizziness, confusion, irritability, trembling, weakness, hunger. Drowsiness is a late sign of hypoglycemia but does not always require treatment by emergency medical personnel. The presence of urinary ketone bodies is a sign of diabetic ketoacidosis, and testing is only indicated if the presenting symptoms suggest that diagnosis. If the patient is highly active, then the insulin requirement may be reduced for that next dose because exercise increases insulin sensitivity in skeletal muscle. However, it does not mean the evening dose can be skipped altogether.