Let’s Save a Life Let’s Save a Life with Glucagonwith GlucagonRachel Gallagher, RN, CPNP, NCSNRachel Gallagher, RN, CPNP, NCSNFormer School Nursing ConsultantFormer School Nursing Consultant

This power point, and competency test will satisfy the This power point, and competency test will satisfy the knowledge portion of medication training. knowledge portion of medication training.

To complete the medication training for this To complete the medication training for this emergency medication, school personnel will need emergency medication, school personnel will need to have a their medication administration skill to have a their medication administration skill verified and documented by a school nurse, verified and documented by a school nurse, medical provider or adequately training parent by medical provider or adequately training parent by performing an independent demonstration of the performing an independent demonstration of the skill. skill.

Competency checklist are available at: Competency checklist are available at: http://dpi.wi.gov/sspw_schlnurse.htmlhttp://dpi.wi.gov/sspw_schlnurse.html

OverviewOverview

What is diabetes?What is diabetes? What is the prevalence of diabetes?What is the prevalence of diabetes? What are the causes of low blood sugar?What are the causes of low blood sugar? What are the symptoms of low blood sugarWhat are the symptoms of low blood sugar What are the school management What are the school management

responsibilities for children with diabetes?responsibilities for children with diabetes? What is glucagon?What is glucagon? How is it prepared and administered?How is it prepared and administered? What are the side effects of glucagon?What are the side effects of glucagon?

What is Diabetes?What is Diabetes?

Chronic DiseaseChronic Disease

Two types – Type 1 and Two types – Type 1 and Type 2Type 2

Type 1 Diabetes – Body Type 1 Diabetes – Body does not produce enough does not produce enough insulin. Insulin is needed to insulin. Insulin is needed to produce energy from the produce energy from the food we eat.food we eat.

Balance between food, Balance between food, exercise and insulin to keep exercise and insulin to keep blood sugar in the normal blood sugar in the normal range (80-120 mg/dl) range (80-120 mg/dl)

What is the prevalence of What is the prevalence of Diabetes?Diabetes?

186,300 students with diabetes under 186,300 students with diabetes under the age of 20the age of 20

1 in every 400 to 600 children1 in every 400 to 600 children

8% of population of adults and 8% of population of adults and childrenchildren

What are the school What are the school responsibilities for students responsibilities for students with diabetes?with diabetes?

Identification of students with diabetesIdentification of students with diabetes School policy and procedure for diabetes School policy and procedure for diabetes

managementmanagement Emergency and Individual Health Care PlanEmergency and Individual Health Care Plan Training of staff on disease, medications, Training of staff on disease, medications,

and emergency planand emergency plan Minimize impact to the student’s educationMinimize impact to the student’s education

What are the causes of What are the causes of low blood sugar?low blood sugar?

Too much insulinToo much insulin Not enough foodNot enough food Too much exerciseToo much exercise Illness/InjuryIllness/Injury Certain medicationsCertain medications Alcohol Alcohol

consumptionconsumption

What are the symptoms of What are the symptoms of low blood sugar? low blood sugar?

Blood Sugar below 70 mg/dLBlood Sugar below 70 mg/dLSweatingSweating Drowsiness DrowsinessDizzinessDizziness Sleep disturbance Sleep disturbancePalpitations AnxietyPalpitations AnxietyHungerHunger Blurred vision Blurred visionRestlessness Slurred speechRestlessness Slurred speechTingling of extremities Depressed moodTingling of extremities Depressed moodLightheadedness IrritabilityLightheadedness IrritabilityInability to concentrateInability to concentrate Abnormal behavior Abnormal behaviorHeadaches Unsteady movementHeadaches Unsteady movement

Treated with fast acting sugarTreated with fast acting sugar

What are the Symptoms of What are the Symptoms of Severe Low Blood Sugar or Severe Low Blood Sugar or Insulin Shock? Insulin Shock?

Typically occurs with blood sugar below 40 mg/dL, Typically occurs with blood sugar below 40 mg/dL, however every individual with Type 1 Diabetes however every individual with Type 1 Diabetes

reacts differently!reacts differently! DisorientationDisorientation

UnconsciousnessUnconsciousness

SeizureSeizure

DeathDeathMedical Emergency!Medical Emergency!

What is glucagon?What is glucagon?

Hormone - raises blood sugarHormone - raises blood sugar

Unstable – needs to be used immediately after Unstable – needs to be used immediately after mixing.mixing.

Store kit in temperature between 68-77 FStore kit in temperature between 68-77 F

Dosage - consult medical provider medication and Dosage - consult medical provider medication and parent authorization formsparent authorization forms>44 pounds full amount>44 pounds full amount<44 pounds ½ amount<44 pounds ½ amount

Wisconsin Law and Wisconsin Law and GlucagonGlucagon

School personnel may administer School personnel may administer glucagon to any student with known glucagon to any student with known diabetes and symptoms of a severe diabetes and symptoms of a severe low blood sugar with altered state of low blood sugar with altered state of consciousness without a medical consciousness without a medical provider or parent authorization.provider or parent authorization.

Wis. Stat. Ch. 118.29Wis. Stat. Ch. 118.29

Steps to glucagon Steps to glucagon administration administration

1. Obtain the kit and have school staff person call 9111. Obtain the kit and have school staff person call 911

2. Put on gloves2. Put on gloves

2. Open the kit2. Open the kit

3. Remove the seal from the bottle of glucagon3. Remove the seal from the bottle of glucagon

4. Remove the needle protector from the syringe that 4. Remove the needle protector from the syringe that is pre-filled with liquidis pre-filled with liquid

5. Inject the liquid from the syringe into the bottle of 5. Inject the liquid from the syringe into the bottle of glucagon glucagon

6. Do not remove the syringe from bottle6. Do not remove the syringe from bottle

Steps continuedSteps continued

7. Swirl bottle and syringe gently until solution is 7. Swirl bottle and syringe gently until solution is clear or remove syringe protecting needle and clear or remove syringe protecting needle and swirl.swirl.

8. Reattach syringe if needed. Withdraw the liquid 8. Reattach syringe if needed. Withdraw the liquid using the needle attached to the bottle (school using the needle attached to the bottle (school nurse will instruct you as to amount to draw up; nurse will instruct you as to amount to draw up; amount may be different for each student).amount may be different for each student).

9. Administration of medication (training by school 9. Administration of medication (training by school nurse) in buttock, arm or thigh (preferred)nurse) in buttock, arm or thigh (preferred)

10. Monitor student10. Monitor student11. Carefully remove gloves 11. Carefully remove gloves 12. Dispose of syringe in sharps disposal box.12. Dispose of syringe in sharps disposal box.

DemonstrationDemonstration

After Glucagon After Glucagon administrationadministration

Position on side – often will vomit!!!

Will awake within 15 minutes Call 911, if not already done Begin CPR as needed Notify parent and medical

provider Upon awakening, check blood

sugar and feed as appropriate If not awake in 15 minutes,

administer another dose of glucagon or as indicated in medical provider authorization form

What are the side effects What are the side effects of glucagon?of glucagon?

NauseaNausea VomitingVomiting RashRash Rapid heart rateRapid heart rate Trouble breathingTrouble breathing

DocumentationDocumentation

Every dose of medication needs to be Every dose of medication needs to be documented with the date, time and documented with the date, time and initials of the person administering the initials of the person administering the medication on the medication log. medication on the medication log.

To Download this To Download this PowerPoint Presentation, PowerPoint Presentation, go to:go to:

http://www.dpi.wi.gov/sspw/doc/sninsulinshock.dochttp://www.dpi.wi.gov/sspw/doc/sninsulinshock.doc

Questions!!!Questions!!!

School NurseSchool Nurse

Medical ProviderMedical Provider

ParentParent

Any comments regarding this webcast?Any comments regarding this webcast?Any suggestions on future school Any suggestions on future school

nursing topics?nursing topics?

Contact:Contact:WI Dept. of Public InstructionWI Dept. of Public InstructionSchool Nursing ConsultantSchool Nursing Consultant(608) 266-8857(608) 266-8857

Take test.Take test.Upon completion, take Upon completion, take

test to nurse or test to nurse or administrator for scoring.administrator for scoring.