Transcript No Slide Title

Diabetes Care Tasks at School:
What Key Personnel
Need to Know
MANAGING HYPOGLYCEMIA
AND HYPERGLYCEMIA
Overall goal:
Optimal student health and learning
Monitoring
Blood
Glucose
Glucagon
Administration
Hypoglycemia &
Hyperglycemia
Ketones
Health
&
Legal
Rights
Learning
Insulin
Exercise
Administration
Nutrition
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Managing
hypoglycemia and
hyperglycemia are
critical to student
success. But just
one piece of a
comprehensive
management plan.
Learning Objectives
Participants will learn:
 Symptoms
of high and low blood glucose
 Short- and long-term risks
 Treatment of high and low blood glucose
 Prevention of high and low blood glucose
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Vocabulary
Glucose - a simple sugar found in the blood. the fuel that all body
cells need to function.
HYPOglycemia - a LOW level of glucose in the blood.
Quick-acting glucose - foods containing simple sugar that
raises blood glucose levels
Glucose tablets or gel - special products that deliver a premeasured amount of pure glucose. They are a fast-acting form of glucose
used to counteract hypoglycemia.
Glucagon - a hormone given by injection that raises the level of
glucose in the blood.
Carbohydrate - source of energy for the body.
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HYPOglycemia = LOW sugar
Onset:
–
–
–
sudden,
may progress to unconsciousness if not treated
can result in brain damage or death
The DMMP should specify signs and action
steps each level of severity:
–
–
–
mild
moderate
severe
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Hypoglycemia:Risks & Complications

Greatest immediate danger

Not always preventable

Impairs cognitive and motor functioning

Early recognition and intervention can
prevent an emergency
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Hypoglycemia: Possible Causes

Too much insulin

Too little food or delayed meal
or snack

Extra physical activity

Illness

Medications
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Hypoglycemia:
Possible Signs & Symptoms
Mild Symptoms
Hunger
Sleepiness
Shakiness
Changed behavior
Weakness
Sweating
Paleness
Anxiety
Blurry vision
Dilated pupils
Increased heart rate/palpitations
Moderate to Severe Symptoms
Yawning
Confusion
Irritability/frustration
Restlessness
Extreme tiredness/fatigue
Dazed appearance
Inability to swallow
Unconsciousness/coma
Sudden crying
Seizures
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Mild Hypoglycemia: What to do





Intervene promptly. Follow DMMP.
Verify with blood glucose test when available.
When in doubt, always treat. If no meter is available, treat immediately.
If untreated may progress to more serious events.
Treat on the spot.
Have student eat or drink fast acting carbs (15g)
– Test blood glucose 10-15 minutes after treatment
– Repeat treatment if blood glucose level remains low or if symptoms persist per
DMMP
– Duration of symptoms depends on how low the blood glucose was and for how long
– If symptoms continue, call parents per DMMP
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Quick Acting Glucose
for Hypoglycemia
Treatment for Lows: 15 g Carbohydrate
 4 oz. fruit juice
 15 gm glucose tablets (2-3 tablets)
 1 tube of glucose gel
 4-6 small hard candies
 1-2 tablespoons of honey
 6 oz. regular (not diet) soda (about half a can)
 3 tsp. table sugar
 One-half tube of cake mate
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Severe Hypoglycemia Symptoms



Convulsions (seizures)
Loss of consciousness
Inability to swallow
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Severe Hypoglycemia: What to do
Rare, but life threatening, if not treated promptly:

Place student on his or her side.
Lift chin to keep airway open.

Inject glucagon, per student’s DMMP.

Never attempt to give food or put anything in the
student’s mouth.

Call 911, then parent/guardian.

Student should respond in 10 to 20 minutes.

Remain with the student until help arrives.

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Hypoglycemia: Prevention
Keep a quick-acting sugar source with the student.
ALWAYS.
 Treat at onset of symptoms
 Eat, Insulin, Test, Exercise ON TIME.
 Ensure reliable insulin dosing, per DMMP.
 Ensure insulin dosing matches food eaten.




Watch picky eaters
Provide nutritional information to families
May give insulin after eating if intake uncertain
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Hypoglycemia: Prevention
 Consult
with parent/guardian when snack, meal or
exercise times must be changed.
 Monitor
blood-glucose variations on gym days, an
extra snack may be required ½ hour before gym or
during prolonged vigorous exercise per DMMP.
 A student
should never be unattended when a low
blood glucose is suspected. Maintain adult
supervision.
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Vocabulary
Hyperglycemia - too high a level of glucose in the blood.
Ketones - (ketone bodies) Chemicals that the body makes when
there is not enough insulin in the blood and the body must
break down fat for its energy.
Diabetic ketoacidosis (DKA) - the build up of ketones in
the body that can lead to serious illness and coma.
Ketone testing - a procedure for measuring the level of
ketones in the urine or blood.
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HYPERglycemia = HIGH Sugar




Too much sugar in the blood, but cells are starving
Onset:
– Severe hyperglycemia is usually slow to develop
– Can be rapid with pumps
Hyperglycemia due to insufficient insulin may lead to
diabetic ketoacidosis (DKA) if not treated (mainly in type
1)
DMMP should specify signs and action steps at each level
of severity:
–
–
–
Mild
Moderate
Severe
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Hyperglycemia: Risks & Complications

Hyperglycemia due to inadequate insulin can
lead to DKA and/or coma or death (mainly in
type 1).

Interferes with a student’s ability to learn and
participate.

Serious complications develop when glucose
levels remain above target range over time or
are recurring.
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Hyperglycemia: Possible Causes

Late, missed or too little insulin
Expired insulin
Food not covered by insulin
Decreased physical activity

Illness, injury

Stress

Other hormones or medications

Menstrual periods

Any combination of the above



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Hyperglycemia: Possible Signs &Symptoms
Severe Symptoms
Labored breathing
Confused
Very weak
Unconscious
Moderate Symptoms
Dry mouth
Stomach cramps
Vomiting
Nausea
Mild Symptoms
Lack of concentration
Thirst
Frequent urination
Flushing of skin
Sweet, fruity breath
Fatigue/sleepiness
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Blurred vision
Increased hunger
Weight loss
Stomach pains
Hyperglycemia: What to do
Goal: lower the blood glucose to a target range.
Follow DMMP
•
•
•
•
•
•
•
Verify with blood glucose test.
Check ketones per DMMP.
Allow free use of bathroom and access to water.
Administer insulin per DMMP.
Recheck blood glucose per DMMP.
Call parents per DMMP.
Note patterns: may need a change in regimen.
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Hyperglycemia: Prevention

Eat, insulin, check BG, exercise ON TIME.

Reliable and accurate insulin dosing, per DMMP.

Ensure that food eaten matches insulin dosing:




Monitor food intake per DMMP
Report binge eating
Teachers consult parent/guardian prior to extra
snacks.
Consult with parent/guardian when snack, meal,
or exercise times must be changed.
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Hyperglycemia: Prevention

Take appropriate action if a missed dose is
suspected or if an insulin pump malfunctions.

Avoid “over treating” low blood sugar
reactions.

Respect the students; realize their limits.

Exercise on a regular basis.
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Practical Implications for Educators

Students with hyperglycemia or hypoglycemia often do not
concentrate well.

During academic testing:
 Check blood glucose before and during testing, per
educational plan.
 Access to food/drink and restroom.
 If a serious high or low blood glucose episode occurs,
students should be excused with an opportunity for retake.

Students should have adequate time for taking medication,
checking blood glucose, and eating.
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Practical Implications for Educators

“Make the right choice the easy choice” by
eliminating barriers to:
–
–
–
–

snacking
blood glucose checks
access to water and bathrooms
insulin administration
Avoid making judgments based on
individual blood glucose readings.
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