HYPOGLYCEMIA/GL

UCAGON®

Jennifer Sellers, RN,CDEACH Diabetes Team

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)

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

Target Blood Sugar Ranges Below age 5 years: 80-200 mg/dl 5-12 years: 70-170 mg/dl Teenagers: 70-150 mg/dl

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

Symptoms of Hypoglycemiaheadache irritabilityconfusionsweating

weaknessrapid heart rateshakinesspersonality

changes

Treatment of HypoglycemiaTreat any blood sugar below 70,

using Rule of 15

For seizure or unconsciousness, use Glucagon Emergency Kit® as prescribed

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.

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

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

What NOT to use to treat low blood sugar…

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

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

Glucagon®/Glucagen®

Glucagon Emergency Kit®

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

REMEMBERYOU CANNOT OVERDOSE

GLUCAGON®

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

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?

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

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…

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…

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.

Case Scenario 3 You are called to the classroom to find a

student with diabetes having a seizure. How do you proceed?

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

QUESTIONS

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