Diabetes Training for Diabetes Training for School EmployeesSchool Employees

Albemarle County Public Albemarle County Public SchoolsSchools

Purpose of this PresentationPurpose of this Presentation

The purpose of this presentation is to The purpose of this presentation is to provide information for use in the provide information for use in the training of school personnel in the training of school personnel in the management of diabetes including management of diabetes including the administration of insulin and the administration of insulin and glucagon as required by the Code of glucagon as required by the Code of Virginia. Virginia.

DiabetesDiabetes in Schools: in Schools: LegislationLegislation

Virginia Senate Bill 889Virginia Senate Bill 889 requires public schools with at requires public schools with at least one student diagnosed with least one student diagnosed with diabetes to ensure that at least diabetes to ensure that at least two employees have been two employees have been trained in the administration of trained in the administration of insulin and glucagon. insulin and glucagon. http://leg1.state.va.us/cgi-bin/leghttp://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-274 p504.exe?000+cod+22.1-274

Section 504 of the Section 504 of the Rehabilitation Act of 1973Rehabilitation Act of 1973 Requires all public schools to Requires all public schools to afford children with disabilities afford children with disabilities (including diabetes) an equal (including diabetes) an equal opportunity to participate in all opportunity to participate in all academic as well as academic as well as nonacademic and extracurricular nonacademic and extracurricular services and activities regardless services and activities regardless of disabilityof disability..

Diabetes Medical Management Diabetes Medical Management PlanPlan A medical management plan must be A medical management plan must be

provided for each student with diabetes provided for each student with diabetes (Individualized Health Care Plan – IHCP) (Individualized Health Care Plan – IHCP) completed by the students’ medical completed by the students’ medical management team and signed by both management team and signed by both the health care provider and the the health care provider and the student’s parent. student’s parent.

Components of the PlanComponents of the Plan Contact InformationContact Information – parent and provider – parent and provider Blood glucose monitoringBlood glucose monitoring: when, where, : when, where,

and how independent the student isand how independent the student is InsulinInsulin: when, type, amount, how (pen, : when, type, amount, how (pen,

syringe, pump), by whom (student, nurse)syringe, pump), by whom (student, nurse) DietDiet: Meals and snacks: time, amount: Meals and snacks: time, amount Treatment/management of low blood Treatment/management of low blood

sugarsugar.. Treatment/management of high blood Treatment/management of high blood

sugarsugar. .

BASICS of DIABETES MANAGMENTBASICS of DIABETES MANAGMENT

Blood glucose testingBlood glucose testing

Insulin administrationInsulin administration

Diet – carb countingDiet – carb counting

ExerciseExercise

Recognizing and treating high Recognizing and treating high blood sugar and low blood sugarblood sugar and low blood sugar

Emergency treatment of severe Emergency treatment of severe low blood sugarlow blood sugar

Blood Glucose Blood Glucose MonitoringMonitoring

Different kinds of metersDifferent kinds of meters Must be calibrated to match test Must be calibrated to match test

stripsstrips

Examples of GlucometersExamples of Glucometers

Freestyle One Touch Freestyle One Touch Ascenia Ascenia

When to Check Blood GlucoseWhen to Check Blood Glucose

Students may check their blood Students may check their blood glucoseglucose:: Before eating snacks or mealsBefore eating snacks or meals

Before physical activity Before physical activity

When they have symptoms of low or When they have symptoms of low or high blood glucosehigh blood glucose

Other times per planOther times per plan

Blood Blood Glucose Monitoring SkillsGlucose Monitoring Skills

Wash & dry hands.Wash & dry hands. Insert test strip in glucose meterInsert test strip in glucose meter Select appropriate site on the fingertip Select appropriate site on the fingertip

(top or sides).(top or sides). Puncture fingertip accurately and Puncture fingertip accurately and

obtain optimal amount of blood to obtain optimal amount of blood to perform accurate measurement.perform accurate measurement.

Place drop of blood on test strip.Place drop of blood on test strip. Obtain accurate reading.Obtain accurate reading. Record blood glucose results. Record blood glucose results.

INSULININSULIN

All people with Type 1 Diabetes manage All people with Type 1 Diabetes manage their diabetes with insulin.their diabetes with insulin.

Old method: Long-acting (basal) insulin Old method: Long-acting (basal) insulin and 2 doses of intermediate acting and 2 doses of intermediate acting insulin.insulin.

New method: Long acting (Lantus, New method: Long acting (Lantus, Levemir, Ultralente) and 3 shorter acting Levemir, Ultralente) and 3 shorter acting doses (Humalog/Novalog) at mealtimes doses (Humalog/Novalog) at mealtimes based on amount of carbohydrates in based on amount of carbohydrates in meal.meal.

Carbohydrate CountingCarbohydrate Counting Used in conjunction with a combination of long Used in conjunction with a combination of long

acting (eg. Lantus) once a day with short acting acting (eg. Lantus) once a day with short acting (Humalog or Novalog) with each meal. (Humalog or Novalog) with each meal.

Easier to learn than Exchanges or the Point System.Easier to learn than Exchanges or the Point System. Food and insulin match better. Food and insulin match better. Increased variety of food choices. Increased variety of food choices. More flexibility in meal/snack times. More flexibility in meal/snack times. Better blood sugar control. Better blood sugar control. Carbohydrate information on food labels makes meal Carbohydrate information on food labels makes meal

planning easier. planning easier. Focus is on carbohydrates, but protein and fat are Focus is on carbohydrates, but protein and fat are

still important.still important. Count total carbohydrates.Count total carbohydrates.

Food LabelFood LabelNutrition FactsNutrition Facts

Serving Size: 1 cup (253 g) Servings per container: 2Serving Size: 1 cup (253 g) Servings per container: 2

Amount per servingAmount per serving % Daily Values% Daily Values

260 calories260 calories

Total fat 8 gTotal fat 8 g 13%13%

Sat. fat 3 gSat. fat 3 g 17%17%

Cholesterol 130 mgCholesterol 130 mg 44%44%

Sodium 1010mgSodium 1010mg 42%42%

Total Carbohydrate 22 gTotal Carbohydrate 22 g 7%7%

Dietary Fiber 9 gDietary Fiber 9 g 36 %36 %

Sugars 4 gSugars 4 g

Protein 25 gProtein 25 g

Tools for Carbohydrate CountingTools for Carbohydrate Counting

Albemarle County Child Nutrition Albemarle County Child Nutrition ServicesServices: : http://schoolcenter.k12albemarle.org/educathttp://schoolcenter.k12albemarle.org/education/sctemp/a93ebbb902ffa8b10a8102e55bdion/sctemp/a93ebbb902ffa8b10a8102e55bd84ddf/1194888543/carb_cts_.xls84ddf/1194888543/carb_cts_.xls

USDA: USDA: http://www.nal.usda.gov/fnic/foodcomp/http://www.nal.usda.gov/fnic/foodcomp/

search/ search/ Fast food:Fast food:http://http://www.bddiabetes.com/resource.aspx?IDXwww.bddiabetes.com/resource.aspx?IDX=4253=4253

Types of Insulin, Dosages & TimesTypes of Insulin, Dosages & TimesSample PlanSample Plan

InsulinInsulin Pre-BreakfastPre-Breakfast

HumalogHumalogPre-LunchPre-Lunch

HumalogHumalogPre-DinnerPre-Dinner

HumalogHumalog

Lantus: 10 units Lantus: 10 units before before breakfastbreakfast

DailyDaily

Carb RatioCarb Ratio: : _1___1__ units for units for everyevery15_15_ grams grams carbs eatencarbs eaten

Carb Ratio:Carb Ratio: __1__1__ units for units for every every 15 15 grams grams carbs eatencarbs eaten

Carb RatioCarb Ratio: : 11

units for every units for every 1515 grams carbs grams carbs eateneaten

Adjust for Adjust for blood blood glucose glucose readingreading

Correction Correction FactorFactor::

AddAdd 1 1 unit for unit for every every 50 50 mg/dl mg/dl above above 150150

SubtractSubtract: : 1 1 units units for every for every 20 20 mg/dl mg/dl below below 100 100 mg/dlmg/dl

Correction Correction FactorFactor::

AddAdd 1 1 unit for unit for every every 50 50 mg/dl mg/dl above above 150150

SubtractSubtract: : 1 1 units units for every for every 20 20 mg/dl mg/dl below below 100 100 mg/dlmg/dl

Correction Correction FactorFactor::

AddAdd 1 1 unit for unit for every every 50 50 mg/dl mg/dl above above 150150

SubtractSubtract: : 1 1 units units for every for every 20 20 mg/dl mg/dl below below 100 100 mg/dlmg/dl

If dose is half If dose is half unit, round up. unit, round up. For Carb count For Carb count round down round down

If dose is half If dose is half unit, round up. unit, round up. For Carb count For Carb count round downround down

If dose is half If dose is half unit, round up. unit, round up. For Carb count For Carb count round downround down

Calculating Insulin Dose:Calculating Insulin Dose:Pens and PumpsPens and Pumps

Determine amount based on plan: Determine amount based on plan: Step 1: Calculate number of carbs in Step 1: Calculate number of carbs in

meal then determine the prescribed meal then determine the prescribed ratio (eg. 1 unit for each 15 grams ratio (eg. 1 unit for each 15 grams carbs). carbs).

Step 2: Correction factor for blood Step 2: Correction factor for blood glucose reading (add insulin for higher glucose reading (add insulin for higher blood sugar reading and subtract for blood sugar reading and subtract for lower reading).lower reading).

ExampleExample from Sample Plan from Sample Plan

Student’s lunch contains 60 grams of Student’s lunch contains 60 grams of carbs and his blood sugar reading is carbs and his blood sugar reading is 160mg/dl.160mg/dl.

Step 1: 1 unit for each 15 grams = 4 Step 1: 1 unit for each 15 grams = 4 unitsunits

Step 2: Correction factor: add 1 unit for Step 2: Correction factor: add 1 unit for blood sugar reading of 160mg. blood sugar reading of 160mg.

Insulin dose = 5unitsInsulin dose = 5units

More Examples from Sample PlanMore Examples from Sample PlanCalculating Insulin DoseCalculating Insulin Dose

Grams of Grams of carbscarbs

Blood Blood SugarSugar

Amount of Amount of Insulin (Dose)Insulin (Dose)

80 g (5.3 units 80 g (5.3 units round down)round down)

80 mg/dl80 mg/dl

(minus 1 (minus 1 unit)unit)

4 units4 units

75 g (5 units)75 g (5 units) 360 (plus 5 360 (plus 5 units)units)

10 units10 units

65 g (4 units 65 g (4 units round down)round down)

90 (no 90 (no correction)correction)

4 units4 units

100 g (6 units 100 g (6 units round down)round down)

175 (plus 1 175 (plus 1 unit)unit)

7 units7 units

Insulin ChartInsulin ChartInsulin Chart

For physician ordered sliding scale of 1 unit for every 15 grams of carbs consumed Correction factor for blood sugar readings: Add 1 unit for every 50 above 150 Subtract 1 unit for every 20 below 80 Follow all orders regarding parameters to call parent for high or low blood sugar or when unsure.

Blood Sugar Readings 60-79 80 - 99 100-149 150-199 200-249 250-299 300-349 350-399 400-499 >450

15 - 29 0 0 2 3 4 5 6 7 8 9 30 - 44 0 1 3 4 5 6 7 8 9 10 45 - 59 1 2 4 5 6 7 8 9 10 11 60 - 74 2 3 5 6 7 8 9 10 11 12 75 - 89 3 4 6 7 8 9 10 11 12 13 90 - 104 4 5 7 8 9 10 11 12 13 14 105-119 5 6 8 9 10 11 12 13 14 15 120-134 6 7 9 10 11 12 13 14 15 16

C A R B S

135-149 7 8 10 11 12 13 14 15 16 17

Types of Insulin InjectionsTypes of Insulin InjectionsTypes of Insulin InjectionsTypes of Insulin Injections::

1.1. Vials and syringesVials and syringes

2.2. Insulin pensInsulin pens

3.3. Insulin pumpsInsulin pumps

Insulin Vials and SyringesInsulin Vials and Syringes

Insulin Vial and SyringesInsulin Vial and Syringes

Insulin PensInsulin Pens

Insulin PumpsInsulin Pumps

For All Types of Insulin SkillsFor All Types of Insulin Skills

Determine appropriate storage & Determine appropriate storage & security of insulin, syringes, & medical security of insulin, syringes, & medical supplies.supplies.

State where plan is located.State where plan is located. State “5 rights” of medication State “5 rights” of medication

administration: student, medication, administration: student, medication, dose, time and route.dose, time and route.

Determine insulin dose per plan. Determine insulin dose per plan. Document amount of insulin and time Document amount of insulin and time

of administration. of administration.

Insulin TypesInsulin TypesNAME LETTER ONSET OF

ACTION PEAK

ACTION DURATION

Regular R 30 min. 2-4hrs 3-6hrs.

Humalog/Novolog* 10 - 20 min. 1-3 hrs. 3-5 hrs

Semilente S 1-2 hours 2-8 hours 10-16 hours

NPH N 2-4hrs. 4-10 hrs. 1O-l8 hrs.

Lente L 2-4hrs. 4-l2hrs. 12-2O hrs.

UltraLente U 6-l2hrs No Peak 18-3O hrs.

Lantus (glargine) G 1 hr No Peak 18-26 hrs

Detemir/Levemir 1-3 hrs 8-10 hrs. 18 -24 hrs.

70/30 70/30 It is pre mixed and works like 70% NPH and 30% Regular

50/50 50/50 II is pre mixed and works like 50% NPH and 50% Regular

*Humalog/Novolog

Works so quickly it should be taken no sooner than 15 minutes before a meal. Just a word of caution, hypoglycemia may be a factor when using Humalog.

Pre-Mixed Insulins: 50/50 or 70/30 Combined Regular and NPH or Lente insulins. 50/50 is 50% NPH and 50% Regular 70/30 is 70% NPH and 30% Regular

Preparing for Insulin Injection: Steps Preparing for Insulin Injection: Steps 1 through 41 through 4 Step 1: Remove capStep 1: Remove cap

Step 2: Wipe the top Step 2: Wipe the top with alcohol swabwith alcohol swab

Step 3: Draw air into Step 3: Draw air into the syringe equal to the syringe equal to the dosethe dose

Step 4: Put the needle Step 4: Put the needle through the rubber top through the rubber top of the vial and push of the vial and push the plunger to inject the plunger to inject air into the vialair into the vial

Preparing for Insulin Injection:Preparing for Insulin Injection: Steps 5 through 7 Steps 5 through 7

Step 5: Step 5: Draw up doseDraw up dose Leave Leave syringe in the vial and turn both syringe in the vial and turn both upside down. Hold the syringe and upside down. Hold the syringe and fial firmly in one hand. Make sure fial firmly in one hand. Make sure the tip of theneedle is in the insulin the tip of theneedle is in the insulin

Step 6: Step 6: Check for bubbles Check for bubbles Before you take the needle out of Before you take the needle out of the vial, check the syringe for the vial, check the syringe for bubblesbubbles

Step 7Step 7: : Tap to releaseTap to release If If bubbles are in the medicine, hold bubbles are in the medicine, hold the syringe straight up and tap the the syringe straight up and tap the side of the syringe until the bubbles side of the syringe until the bubbles float to the top. Push the bubbles float to the top. Push the bubbles out with the plunger and draw the out with the plunger and draw the insulin back in until you have the insulin back in until you have the correct dose. correct dose.

Injection InstructionsInjection Instructions Gather together the insulin-loaded Gather together the insulin-loaded

syringe or pen, an alcohol swab and syringe or pen, an alcohol swab and a dry cotton swab or tissue.a dry cotton swab or tissue.

Select the injection site (illustration).Select the injection site (illustration). Swab the site with an alcohol swab. Swab the site with an alcohol swab. Gently pinch up the skin and fat Gently pinch up the skin and fat

with the thumb and forefinger.with the thumb and forefinger. Hold the syringe like a pencil, close Hold the syringe like a pencil, close

to the needle for better control.to the needle for better control. Push the needle in quickly and all Push the needle in quickly and all

the way, at a 90-degree angle to the the way, at a 90-degree angle to the pinched-up skin.pinched-up skin.

Push the plunger in to inject the Push the plunger in to inject the insulin.insulin.

Slowly let go of the pinched-up skin Slowly let go of the pinched-up skin and then remove the needle.and then remove the needle.

Using a dry swab, apply gentle Using a dry swab, apply gentle pressure to the injection site to pressure to the injection site to prevent bruising.prevent bruising.

Discard the needle and syringe in Discard the needle and syringe in the sharps container. To avoid the sharps container. To avoid possible injury, never leave used possible injury, never leave used needles lying around. needles lying around.

Insulin Pen Injection SkillsInsulin Pen Injection Skills

Determine amount of insulin to be Determine amount of insulin to be administered based on plan.administered based on plan.

Prepare pen by applying needle Prepare pen by applying needle appropriately.appropriately.

Prime the pen with 2 units – dial 2 and push Prime the pen with 2 units – dial 2 and push plunger to dispense the two into trashcan. plunger to dispense the two into trashcan.

Dial the correct dose to be administered.Dial the correct dose to be administered. Demonstrate accurate injection technique.Demonstrate accurate injection technique. Dispose of used needle correctly.Dispose of used needle correctly. Document amount of insulin and time Document amount of insulin and time

administered. administered.

Insulin Vials and Syringes SkillsInsulin Vials and Syringes Skills

Assemble supplies: vials, syringes, Assemble supplies: vials, syringes, alcohol pads.alcohol pads.

Accurately measure insulin dose with Accurately measure insulin dose with syringe.syringe.

Locate appropriate sites for injection.Locate appropriate sites for injection. Demonstrate accurate injection Demonstrate accurate injection

technique.technique. Dispose of syringes in sharps container. Dispose of syringes in sharps container. Record amount of insulin and time Record amount of insulin and time

administered. administered.

Insulin PumpsInsulin Pumps

Pumps vary by manufacturer. Pumps vary by manufacturer. Calculate amount of bolus at meal Calculate amount of bolus at meal

time per plan.time per plan. Enter the amount on pump per Enter the amount on pump per

instructions. instructions. Record the amount of bolus. Record the amount of bolus.

Hyperglycemia (High Blood Sugar)Hyperglycemia (High Blood Sugar) Causes of HyperglycemiaCauses of Hyperglycemia: : - Too much foodToo much food- Too little insulinToo little insulin- Decreased activityDecreased activity- IllnessIllness- InfectionInfection- StressStress

Symptoms of HyperglycemiaSymptoms of HyperglycemiaMildMild• ThirstThirst• Fatigue/sleepinessFatigue/sleepiness• Increased hungerIncreased hunger• Blurred visionBlurred vision• Weight lossWeight loss• Stomach painsStomach pains• Flushing of skinFlushing of skin• Lack of concentrationLack of concentration• Sweet fruity breathSweet fruity breath

ModerateModerate• Any of the mild symptomsAny of the mild symptoms• Dry mouthDry mouth• NauseaNausea• Stomach crampsStomach cramps• VomitingVomitingSevereSevere• Any of the mild or Any of the mild or

moderate symptoms plus:moderate symptoms plus:• Labored breathingLabored breathing• Very weakVery weak• ConfusedConfused• UnconsciousUnconscious

Symptoms of HyperglycemiaSymptoms of Hyperglycemia

Symptoms of Hyperglycemia

MildThirst

Frequent urinationFatigue

Increased hungerBlurred vision

Stomach painsFlushing skin

Inability to concentrateSweet, fruity breath

ModerateMild symptoms plus

Dry mouthNausea

Stomach crampsVomiting

SevereMild and moderate symptoms plus

Labored breathingVery weakConfused

Unconscious

Treatment for Hyperglycemia: High Treatment for Hyperglycemia: High Blood SugarBlood Sugar Allow free use of the bathroom.Allow free use of the bathroom. Encourage student to drink water.Encourage student to drink water. Check urine for ketones per plan.Check urine for ketones per plan. Follow instructions in plan. Follow instructions in plan. Students who test positive for ketones Students who test positive for ketones

should not participate in p.e. or sports until should not participate in p.e. or sports until ketones are no longer present. ketones are no longer present.

Call parent for high blood sugar per plan. Call parent for high blood sugar per plan. Some students’ plan will state that the Some students’ plan will state that the

student needs to go home for blood sugar student needs to go home for blood sugar above a certain number (300 or higher above a certain number (300 or higher depending on the plan). depending on the plan).

Hypoglycemia: Low Blood SugarHypoglycemia: Low Blood Sugar

Causes of low blood sugarCauses of low blood sugar Too much insulinToo much insulin Missed foodMissed food Delayed foodDelayed food Too much or too intense exerciseToo much or too intense exercise

Symptoms of HypoglycemiaSymptoms of HypoglycemiaMildMildHungerHungerShakinessShakinessWeaknessWeaknessPalenessPalenessAnxietyAnxietyDizzinessDizzinessSweatingSweatingDrowsinessDrowsinessPersonality changePersonality changeInability to concentrateInability to concentrate

ModerateModerateHeadacheHeadacheBehavior changeBehavior changePoor coordinationPoor coordinationBlurry visionBlurry visionWeaknessWeaknessSlurred speechSlurred speechConfusionConfusion

SevereSevereLoss of consciousnessLoss of consciousnessSeizureSeizureInability to swallowInability to swallow

IMPORTANT!!!!IMPORTANT!!!!

A student who complains of feeling low A student who complains of feeling low or who you suspect may be low should or who you suspect may be low should never be sent to check blood glucose, never be sent to check blood glucose, to go the nurse’s office or anywhere to go the nurse’s office or anywhere else alone. The student could lose else alone. The student could lose consciousness or become disoriented. consciousness or become disoriented.

Treatment of Mild HypoglycemiaTreatment of Mild Hypoglycemia

Follow plan for parameters for Follow plan for parameters for treatment.treatment.

Provide quick acting source of Provide quick acting source of carbohydrates such as juice or glucose carbohydrates such as juice or glucose tablets per plan.tablets per plan.

Wait 10 to 15 minutes and recheck Wait 10 to 15 minutes and recheck blood glucose.blood glucose.

Student may self treat if permitted by Student may self treat if permitted by plan. plan.

Treatment of Moderate HypoglycemiaTreatment of Moderate Hypoglycemia

Student will need assistance/supervision.Student will need assistance/supervision. Give quick acting carbohydrate per plan.Give quick acting carbohydrate per plan. Wait 10 to 15 minutes and check again. Wait 10 to 15 minutes and check again. Follow parameters of plan for how much Follow parameters of plan for how much

carbohydrate to give and when to repeat if carbohydrate to give and when to repeat if needed. needed.

May administer glucose gel or icing if May administer glucose gel or icing if student is low but conscious and able to student is low but conscious and able to swallow. swallow.

Hypoglycemia – Mild to Moderate (Skills)Hypoglycemia – Mild to Moderate (Skills)

State signs of hypoglycemia.State signs of hypoglycemia. State treatment of mild to moderate State treatment of mild to moderate

hypoglycemia.hypoglycemia. Describe use of glucose gel or icing Describe use of glucose gel or icing

for treatment of hypoglycemia. for treatment of hypoglycemia.

What is GLUCAGON?What is GLUCAGON? A hormone that is made naturally in the A hormone that is made naturally in the

pancreas. It releases stores of glucose from the pancreas. It releases stores of glucose from the liver causing blood glucose levels to rise. liver causing blood glucose levels to rise. Because it is produced naturally it is a safe Because it is produced naturally it is a safe drug -- it cannot be overdosed and it has no drug -- it cannot be overdosed and it has no major side effects. major side effects.

Glucagon injection is used for severe Glucagon injection is used for severe hypoglycemia when the diabetic is unable to hypoglycemia when the diabetic is unable to swallow.swallow.

When injected it causes blood sugar to rise and When injected it causes blood sugar to rise and the person to regain consciousness. the person to regain consciousness.

Glucagon is to be injected into the muscle of Glucagon is to be injected into the muscle of the legs, arms or buttocks.the legs, arms or buttocks.

Treatment of Severe Treatment of Severe Hypoglycemia: GLUCAGONHypoglycemia: GLUCAGON

Glucagon Kit: Lilly Glucagon Kit: Lilly

For video on glucagon administration see For video on glucagon administration see http://web.diabetes.org/video/glucagon.wmvhttp://web.diabetes.org/video/glucagon.wmv

Glucagon Instructions Steps 1 - 3Glucagon Instructions Steps 1 - 3

1.1. Remove the flip off seal from Remove the flip off seal from the bottle of glucagon. Wipe the bottle of glucagon. Wipe rubber stopper on bottle with rubber stopper on bottle with alcohol swab.alcohol swab.

2.2. Remove the needle protector Remove the needle protector from the syringe and inject from the syringe and inject the entire contents of the the entire contents of the syringe into the bottle of syringe into the bottle of powdered glucagon. Do not powdered glucagon. Do not remove the plastic clip from remove the plastic clip from the.the.

3.3. Swirl bottle gently until the Swirl bottle gently until the glucagon dissolves glucagon dissolves completely. Do not shake – completely. Do not shake – shaking may cause bubbles shaking may cause bubbles to form. Glucagon should to form. Glucagon should not be used unless the not be used unless the solution is clear and of a solution is clear and of a water-like consistency. water-like consistency.

Glucagon Instructions Steps 4 throughGlucagon Instructions Steps 4 through 88

4.4. Using the same syringe, Using the same syringe, hold bottle upside down hold bottle upside down and making sure the and making sure the needle tip remains in the needle tip remains in the solution, gently withdraw solution, gently withdraw all of the solution from the all of the solution from the bottle. The plastic clip on bottle. The plastic clip on the syringe will prevent the the syringe will prevent the rubber stopper from being rubber stopper from being pulled out of the syringe.pulled out of the syringe.

5.5. Clean the injection site on Clean the injection site on buttock, arm, or thigh with buttock, arm, or thigh with alcohol.alcohol.

6.6. Insert the needle into the Insert the needle into the loose tissue and inject the loose tissue and inject the amount (half or all per amount (half or all per plan). Apply light pressure plan). Apply light pressure at the injection site and at the injection site and withdraw the needle. withdraw the needle.

7.7. Turn person on side.Turn person on side.8.8. As soon as patient is able As soon as patient is able

to swallow give fast acting to swallow give fast acting sugar such as juice or soft sugar such as juice or soft drink followed by a long drink followed by a long acting source of sugar acting source of sugar such as crackers and such as crackers and cheese or a meat or cheese or a meat or peanut butter sandwich. peanut butter sandwich. Sprite or ginger ale work Sprite or ginger ale work well if stomach is upset. well if stomach is upset.

Severe Hypoglycemia: Glucagon Severe Hypoglycemia: Glucagon SkillsSkills

Accurately state when Glucagon should be Accurately state when Glucagon should be administered.administered.

Describe how to mix and withdraw Glucagon from vial.Describe how to mix and withdraw Glucagon from vial. Determine dose based on plan (0.5mg or 1.0mg).Determine dose based on plan (0.5mg or 1.0mg). Locate appropriate injection sites and injection Locate appropriate injection sites and injection

technique (intramuscular).technique (intramuscular). Precautions: turn child on side, call 9-1-1 & state it is a Precautions: turn child on side, call 9-1-1 & state it is a

diabetic emergency, call parents.diabetic emergency, call parents. Give quick acting carbohydrate such as soft drink Give quick acting carbohydrate such as soft drink

(NOT DIET) when student is awake and can swallow. (NOT DIET) when student is awake and can swallow. Document time and amount of Glucagon Document time and amount of Glucagon

administered. administered.

Sample LogSample LogStudent Name: __________________________

BLOOD GLUCOSE LOG

Date Time Blood Sugar

Food/Carbs Insulin Comments

ConclusionConclusion

As school personnel we want As school personnel we want to ensure that all of our to ensure that all of our students learn and prosper in students learn and prosper in school. By understanding the school. By understanding the basics of diabetes and basics of diabetes and knowing how to care for a knowing how to care for a student with diabetes, you student with diabetes, you will be able to help your will be able to help your student take advantage of all student take advantage of all of the learning and growing of the learning and growing opportunities your school has opportunities your school has to offer. Thank you for to offer. Thank you for interest and willingness to interest and willingness to help your student with help your student with diabetes succeed and thrive diabetes succeed and thrive in school. in school.