Diabetes in SchoolsDiabetes in SchoolsReviewing the New Reviewing the New

LawsLaws

Diabetes in SchoolsDiabetes in SchoolsReviewing the New Reviewing the New

LawsLawsDiane Stewart APN-C, CDEDiane Stewart APN-C, CDE

Blood Sugar less than :Blood Sugar less than :a. 90mg/dl for less than 5 years of agea. 90mg/dl for less than 5 years of ageb. 80 mg/dl for 5-11 years oldb. 80 mg/dl for 5-11 years oldc. 70 mg/dl for 12 years and abovec. 70 mg/dl for 12 years and above

Blood Sugar less than :Blood Sugar less than :a. 90mg/dl for less than 5 years of agea. 90mg/dl for less than 5 years of ageb. 80 mg/dl for 5-11 years oldb. 80 mg/dl for 5-11 years oldc. 70 mg/dl for 12 years and abovec. 70 mg/dl for 12 years and above

What Causes It?

•Too much insulin•Not enough food•Exercise – can lower blood

sugar up to 12 to 18 hours after the exercise

Symptoms:

How to treat hypoglycemia 1

• Test blood sugar

• If blood sugar is low- treat with 15 grams of carbohydrate

– 4 ounces juice apple or orange

– 3 square glucose tablets (not being made any more)

– 4 round glucose tablets

Note:•If blood sugar is 50 mg/dl

or less•Start with 30 grams of

carbohydrates•8 ounces of juice•10 ounces of regular soda

Recheck blood sugar in 15 minutesIf the blood sugar is still too low 1. Give another 15 grams of carbohydrates2. Wait another 15 minutes3. Recheck Blood sugar

How to treat hypoglycemia 2

How to treat hypoglycemia 3

Once it is back in the normal range:if it is NOT time for a meal, give a

snack with protein or fat - OR -

if it IS time for a meal let them eat the meal. If the blood sugar is still high 60’s subtract 15 grams of carbs when calculating the dose

Unconscious Hypoglycemia

• DO NOT inject insulin. • DO NOT provide food or fluids. • DO NOT put hands/fingers in

their mouth. • DO inject glucagon. • DO call for emergency help.

Emergency Kits

Dosage:• Under 100 pounds – give 0.5 or

half• Over 100 pounds – give full dose

1 mg• glucagon forces the liver to release

glucose into the bloodstream. It takes approximately 5 to 15 minutes for the glucagon to work in a diabetic person with low blood sugar.

Important!!• If you give too much glucagon to a

child – you will not harm them.• Blood sugar will stay elevated longer• They may have more nausea and

vomiting• These will subside• This is safer than the hypoglycemia

Hypoglycemia Unawareness

• Hypoglycemia unawareness is when you lose consciousness without ever knowing your blood glucose level was dropping or showing other symptoms of hypoglycemia

• Usually seen when hypoglycemia is not treated quickly on a regular basis.

• Lack of prompt treatment causes the symptoms of hypoglycemia to gradually disappear.

HyperglycemiaHyperglycemiaHyperglycemiaHyperglycemia

(high blood sugar)(high blood sugar)

• Blood sugars can be high for several reasons:– If you eat or drink something and do not

give enough rapid acting insulin or miss a shot

– When you get sick or stressed your body’s natural response can cause blood sugars to rise.

• Whenever your sugar is above 240 you

• should check for urine ketones

• When there is not enough insulin present, sugar cannot be used as fuel so the body makes ketones, by breaking down fat, which do not need insulin to be used by the body.

• A high level of ketones can cause a high acid level in the blood which is bad for the body’s other organs such as the heart.

• Therefore it is very important to know when to check for ketones and what do to when you have them.

Ketone Production Cycle

Cells are starvingBody needsanother fuel

Liver makes ketones

to feed the cells

Not enough insulin

Sugar stays inbloodstream

Ketone Production Cycle

Symptoms:•nauseas•confused•breath smells like alcohol•breathing becomes fast

Acid levels in the bloodrise which can be

dangerous!!!!

Ketone levelsget higher

Treatment of Hyperglycemia:

• If symptoms noted, check blood sugar

• If blood sugar greater than or equal to 240 mg/dl, check urine for ketones

• Dip ketone test strip into urine – wait 15 seconds and match color

If result is moderate or large

• 1. Call doctor

• Have child drink 1-2 cups of water every hour

• Recheck urine for ketones with next void

• If child is vomiting with moderate or large Ketones – they should go

to an emergency room.

It is important to call the MD if moderate or large ketones are present as the insulin correction dosages will not be enough to stop this process.

Snacking• Depends on insulin regime• Basal/Bolus Regime –• 1. does not need a snack if the

dosages are correct• If snack is taken, give insulin

according to the carbohydrate count

NPH or Mixed Insulin Regimes

• May need a mid-morning or afternoon snack to prevent hypoglycemia

• Snacks should be 15-30 grams of carbohydrates

• Note: may need extra snacks if meal intake of carbohydrates was less than recommended amount

Diabetes & Eating Disorders

Seen more due to:1. Rigid dietary regimes2. Heightened emphasis on food3. Weight gain that occurs with the

onset of insulin treatment4. Body image concerns and a strong

preference for thinness as the “ideal” body type among adolescent females

Behaviors Noted:• 1. manipulation and withholding

of insulin to produce glycosuria and weight loss

• 2. use of control solution or other fluids instead of blood when checking blood sugar

• 3. leaving hands wet to dilute blood and show lower BS reading

• 4. taking needle out to soon to• obtain leakage of insulin on

skin

Complications• 1. more frequent diabetic

ketoacidosis• 2. earlier onset of diabetic

complications• 3. increase in retinopathy,

neuropathy and nephropathy• 4. more rapid progression of

complications – microvascular, macrovascular, and psychological