HYPOGLYCEMIA/ GLUCAGON® Jennifer Sellers, RN,CDE ACH Diabetes Team.
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Transcript of HYPOGLYCEMIA/ GLUCAGON® Jennifer Sellers, RN,CDE ACH Diabetes Team.
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HYPOGLYCEMIA/GL
UCAGON®
Jennifer Sellers, RN,CDEACH Diabetes Team
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Blood Glucose TestingChild will be testing blood sugars:
Before meals 2 hours after breakfast/lunch Before bedtime At 2-3 am (for a short time after
discharge from the hospital, then as indicated)
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Blood Glucose Testing Blood sugar values should always be
recorded on record sheets or log book, need to be communicated to parent/guardian on a regular basis
Target ranges will vary depending on child’s age
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Target Blood Sugar Ranges Below age 5 years: 80-200 mg/dl 5-12 years: 70-170 mg/dl Teenagers: 70-150 mg/dl
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WHY??The most common reasons for hypoglycemia
(low blood sugar) are:
Too much insulin administered (questionable carb counting or math error)
Extra or prolonged exercise without extra food
Mistake in drawing/dialing up insulin dose
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Symptoms of Hypoglycemiaheadache irritabilityconfusionsweating
weaknessrapid heart rateshakinesspersonality
changes
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Treatment of HypoglycemiaTreat any blood sugar below 70,
using Rule of 15
For seizure or unconsciousness, use Glucagon Emergency Kit® as prescribed
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RULE OF 15 Treat a low blood glucose with 15 grams of
fast-acting carbohydrate Wait 15 minutes and recheck blood glucose If blood glucose is not above 70 mg/dl, then
retreat with 15 grams, and recheck in 15 minutes
Once blood glucose is corrected, give a small snack, (15 grams of carbohydrate plus a protein) or the regularly scheduled meal within 30 minutes.
If it is a meal time, you must get the blood glucose above 70 before giving the meal/snack.
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Rule of 15: Insulin Pumps For blood sugar 51-70:
o Follow Rule of 15 For blood sugar <50:
o Start temporary basal (5% or –95%, depending on the pump), for 30 minutes
o Give 30 grams of fast-acting carbso Recheck in 15 minutes and continue with
Rule of 15, if not >70
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Examples of 15 gm Fast Acting Carbohydrate
4 ounces juice or regular soda
3 glucose tablets2 pkg Smarties®1 tube glucose
gel1 tube cake icing
gel3 sugar packets
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What NOT to use to treat low blood sugar…
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Glucagon® Is used for severe hypoglycemia resulting in
unconsciousness/seizure activity Is a hormone that stimulates the liver to
release stored glucose Given either IM/SQ, where insulin injections
given Do not give if the student is able to eat or
drink Common side effects: headache, nausea, and
vomiting
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Glucagon®/Seizure Precautions Lay student on the floor on their side to
keep airway open Clear the area around him/her of
anything hard or sharp Do not try to hold student down or stop
movements Loosen any tight clothing, especially
anything around the neck Do not put anything in the mouth
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Glucagon®/Glucagen®
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Glucagon Emergency Kit®
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Glucagon® May take 15-20 minutes for student to
regain consciousness Student may not remember any events
surrounding the severe low blood suagr Blood sugar could likely rise over 200 Headache, nausea, and vomiting are
very common side effects
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REMEMBERYOU CANNOT OVERDOSE
GLUCAGON®
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Recap Check blood sugar for any symptoms of
low blood sugar Student must not be left unattended if low
blood sugar suspected If conscious, treat with Rule of 15 For unconsciousness/having a seizure,
utilize Glucagon ALL low blood sugars need to be relayed to
parents for reporting to the Diabetes Team
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Case Scenario 1Student is escorted to your office stating
they “don’t feel good.” Symptoms of shaking and sweating noted. Student will be going to lunch in 10 minutes. What are the next steps?
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Case Scenario 1 (cont.) Check blood sugar
o Blood sugar 55 Follow Rule of 15
o Recheck 75 Send to lunch, carbs eaten 48 grams
with orders for 1:20 gmso 48/20 = 2.4 = 2 units o Dose for all carbs eaten at lunch
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Case Scenario 2 Student is in PE and starts complaining
of “feeling low.” The coach calls the nurse, stating the student appears confused and lethargic. When you arrive you note the student is also pale and sweaty. Now what…
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Case Scenario 2 (cont.) Check blood sugar
o Blood sugar 50 Follow Rule of 15
o Blood sugar 45 Repeat
o Blood sugar 80
The student has 2 more class periods until lunch…
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Case Scenario 2 (cont.) Give student a snack containing 15
grams of complex carbohydrates and protein
Send student back to normal activity and recheck prior to lunch.
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Case Scenario 3 You are called to the classroom to find a
student with diabetes having a seizure. How do you proceed?
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Case Scenario 3 (cont.) Check blood sugar* Insure safety of student Give Glucagon® Another staff member should contact
EMS and student’s parent/guardian
*do not withhold emergency treatment if meter not close by
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QUESTIONS
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Resources American Diabetes Association,
www.diabetes.org Children with Diabetes,
www.childrenwithdiabetes.com Juvenile Diabetes and Research
Foundation, www.jdrf.org National Diabetes Education
Program www.ndep.nih.gov