Emergency Checklists

Diabetes

* Hyperglycemia occurs when the blood sugar level becomes too high. High Blood Sugar = Blood Sugar (greater than) > 200 mg/dl.

* High blood sugar can be caused by: not enough insulin, too much food, illness, inactivity or stress.

* High blood sugar generally develops over a longer period of time.

* Individuals may display an assortment of symptoms. Symptoms of High Blood Sugar may include:

frequent urination increased thirst increased hunger lethargy blurry Vision stomachache nausea confusion

Severe diabetic complications develop slowly, over several hours or days. Ketoacidosis = High blood glucose with a disturbance in the body’s chemical balance. Life Threatening - unconsciousness - diabetic coma

* At the onset of any symptoms, test blood sugar. * Treat high blood sugar immediately. * If symptoms are displayed and a glucose meter is not available. Treat the potential high! * If blood sugar is over 240 mg/dl, check for ketones. * Ketones are the breakdown products of fat metabolism. A ketone test should be performed in the nurse’s office. Urine is collected in a cup. Then, a * special strip is dipped into the cup of urine. In approximately 15 seconds, the strip will change color. Use the packaging to read the results.

If the individual has HIGH blood sugar and ketones: contact the school nurse and family * immediately. Drink water or sugar free drinks, 1 - 2 cups per hour. (no regular soda or juice)

Do NOT exercise if blood sugar is > 250 mg/dl and ketones are present. * Do NOT exercise if blood sugar is > 350 mg/dl with or without ketones.

High blood sugar can be a warning that this individual is getting sick. Notify the school nurse of * this condition. Notify a parent/a caretaker of this condition

Hypoglycemia – Low Blood Sugar

* Hypoglycemia is a very serious condition - it is often referred to as, Low Blood Sugar = usually Blood Sugar (less than) <70 mg/dl.

* This occurs when there is too much insulin and not enough glucose in the bloodstream. It can happen suddenly...very quickly.

* During hypoglycemia, an individual may display a range of symptoms. These reactions may differ slightly from person-to-person. Examples of Low Blood Sugar may include:

dizziness shakiness pale coloring hunger nervousness nausea irrational behavior confusion personality change crying sweating headache blurry vision sluggishness poor coordination light headed

If this individual is unconscious and cannot swallow, CALL 911 and immediately contact the nurse.

A GLUCAGON Emergency Kit, must be used immediately!

* At the onset of any symptoms, test blood sugar. * Treat low blood sugar immediately. If the symptoms are displayed and a meter is not available - TREAT THE POTENTIAL LOW!!

* If the individual experiences a LOW blood sugar, get them a snack. Wait approximately 15 minutes and then retest blood sugar (BS). If the result is still considered low, add another 15 grams of carbohydrate. Call the family/doctor if this result continues.

* If BS returns to normal and it is close to lunch, have the individual eat. However, if it is not near lunch time, a snack may be necessary. * A Glucagon Emergency Kit consists of a syringe, filled with liquid, that needs to be mixed with a powder. It is a natural hormone that sends a message to the liver or muscles to release stored sugar into the bloodstream.

It is only used in the case of a Severe Hypoglycemic Emergency (seizure, unconsciousness, inability to swallow) and should be administered by a trained individual.

Important Phone Numbers

Name: Address: School / Grade: Date:

Name Number

Parent

Home Phone

Parent

Home Phone

Parent

Cell Phone

Parent

Cell Phone

Parent

Work Number

Parent

Work Number

Doctor

Diabetes Team

Emergency

Contact

Insurance

Company

General Diabetes Information

Name: Address: School / Grade: Date:

Type of Glucose Meter *Include Serial Number

Blood Sugar Testing Information

Can child perform own test? Yes No Adult Supervision needed? Yes No

Insulin Information

Can child inject insulin? Yes No Adult Supervision needed? Yes No

Meals & Snacks

Additional Information

Diabetes Supplies for Home & School

It is the responsibility of the parent/caretaker of the child with diabetes to:

~ Supply the school with all diabetes supplies. ~ Check all expiration dates for food and prescriptions. ~ Check monthly to see if additional supplies are needed.

√ Diabetes Supplies √ Diabetes Supplies

Glucose Meter Glucagon Emergency Kit

Control Solution for Meter Drinks

Batteries for Meter Snacks

Test Strips for Meter Glucose Tablets, Glucose Gel

Lancing Device and Lancets Medical Orders (from Doctor)

Insulin Health Care Plan

Insulin Delivery Supplies School Plan (504 Plan)

Ketone Strips Medical Identification

Testing Results & Instructions

Name: Address: School / Grade: Date:

RESULT COURSE OF ACTION SYMPTOMS (Blood Sugar Reading) What to do

Target

Blood Sugar ------Instructions:

Hypoglycemia

↓ Low Blood Sugar

Instructions:

Hyperglycemia

↑ High Blood Sugar

Blood Sugar Log

Name: Address: School / Grade: Date:

Day Date Time Blood Sugar mg/dl Insulin Dosage Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa Su M T W Th F Sa

Glucagon Emergency Kit for Severe Hypoglycemia

~ A Glucagon Emergency Kit consists of a syringe filled with liquid, which must to be mixed with a powder. The kit comes with all necessary ingredients.

~ It is only used in the case of a Severe Hypoglycemic Emergency. Signs may include: disorientation, unconsciousness, seizures and an inability to swallow.

~ Anyone can be trained to administer this emergency shot. Detailed instructions are inside each kit.

~ Glucagon does NOT contain glucose or sugar. It is a natural hormone that sends a message to the liver or muscles to release stored sugar into the bloodstream.

~ If sugar storage is very low, one shot of Glucagon may not work-another shot may be needed.

~ Contact emergency medical services 9-1-1 – REQUEST A PARAMEDIC!

Step-by-Step Glucagon Instructions

1. Inject the entire liquid contents of the syringe, into the small bottle. (Liquid into powder). Swirl contents in the bottle until mixture is fully dissolved.

2. Use the same syringe, hold bottle upside down. Put the syringe into the bottle and withdraw all liquid.

3. Turn the individual on their side as he/she may vomit.

4. Inject the Glucagon syringe into the arm, leg or buttocks.

5. If the individuals' condition does not improve, a 2nd shot may be necessary.

6. Once the individual is feeling better, a snack with carbohydrates and protein is suggested.

7. **For children 50 pounds and under ask your doctor for specific instructions.

Glucagon Emergency Kit Permission Form

Name: Address: Phone: Date:

To Whom it May Concern:

Glucagon is a hormone made in the pancreas, like insulin. It has the opposite effect of insulin - it RAISES the blood sugar level. IT IS RARELY NEEDED, but it must be available.

If a VERY LOW BLOOD SUGAR occurs and our child loses consciousness and cannot swallow, the Glucagon Emergency Kit must be used. *If necessary, call 911 for back-up.

The school nurse has been trained in the administration of Glucagon.

In addition to the school nurse, the following staff members have been instructed in Glucagon delivery and have our permission to administer it:

Name Signature Date

Parent/Guardian Signature Phone Number Date

Physician Signature Phone Number Date