Sailing around common diabetes emergencies

Barb Schreiner, PhD, APRN, CDE

Navigate a diabetes emergency

• Correct the blood glucose

• Chase down the cause

• Consider what you learned

High BG, ketones, sick days

• 2 key concepts: fluids and insulin

• What ketones tell you

• Fluid management

• Insulin adjustments

 

Time

 

Blood glucose

 

Ketones

 

What to do ? 

7 AM

 

450

 

Large

 

  

9 AM

 

380

 

Large

 

  

12 N

 

350

 

Moderate

 

  

2 PM

 

260

 

Moderate

 

  

4 PM

 

346

 

Small

 

  

6 PM

 

230

 

Moderate

 

  

9 PM

 

180

 

Moderate

 

 

When would you call the diabetes team?

Yes No, not yet

Situation

    Gave 3 extra doses and child no better (still sleepy and won’t drink)

    Gave 2 extra doses, child drinking and eating well, ketones coming down

    Fever, won’t drink

    Breathing hard, looks sick

    Sore throat, blood glucose high but no ketones

    BG high, no ketones, gave usual AM dose, now child won't eat

    Child vomited twice, BG normal, small ketones, due for supper dose

Mini Dose Glucagon Rescue for hypoglycemia during illness

• Check with your diabetes team• Use for:

– BG less than 80 AND– Stomach illness with nausea or vomiting

Age Initial Dose (glucagon drawn with an insulin syringe)

2 years and younger 2 units (20 mcg)2 to 15 years old 1 unit (10 mcg) for year of age 15 and older 15 units (150 mcg)

Mini Dose Glucagon Rescue for hypoglycemia during illness

• BG may rise 60-90 mg/dl; last about one hour. • When to repeat• How to store unused

Age Initial Dose (glucagon drawn with an insulin syringe)

2 years and younger 2 units (20 mcg)2 to 15 years old 1 unit (10 mcg) for year of age 15 and older 15 units (150 mcg)

Finding patterns in the chaos

• What are your BG goals?

• When are BG levels out of target?

• Why are the BG levels out of target?

• How will you bring the BG levels back into target?

When are levels out of target

Brk Lu Su Brk

AA BB CC DD EE FF

Brk Lu Su Brk

AA BB CC DD EE FF

Brk Lu Su Brk

AA BB CC DD EE FF

Why are levels out of target?

• Insulin• Sites• Growth• Hypo• Ketones• Exercise• Diet• Life• Technical