Learning Objectives for HYPERglycemia-HIGH blood sugar Participants will be able to understand: Symptoms of high blood sugar Treatment of high blood sugar Short and long term risks of high blood sugar Above target range KBN 2014

HYPERglycemia=HIGH blood sugar HIGH blood sugar possible causes: Not enough insulin Too much food Above target range The first four items in this list – too little insulin, too much food, not enough physical activity and illness or infection-are the main causes of high blood sugar. As children are going through puberty, hormones also play a role, as well as, the menstrual cycle with girls, the blood sugars can fluctuate. Keeping these in balance, which might require insulin adjustment, is generally what keeps blood glucose from going too high OR too low. Let’s talk about these factors in a little more detail. Too little insulin – Can happen when student forgets to “cover” a meal or snack with rapid-acting insulin. Another concern is when students have not taken their long-acting or basal insulin dose. Students on pumps are especially vulnerable to high blood glucose, if the student’s infusion site (insulin pump catheter) pulls out or tubing occludes, preventing continuous insulin delivery. Too much food or food that is not covered by insulin. This may happen by mistake – not realizing how much carbohydrate is in a particular food. For example, a student who is used to eating grocery store bagels at home, may not realize that some restaurant have bagels twice the amount of carbohydrate. Decreased physical activity- the student may not be as active for different reasons including skipping gym, being sick, etc. Illness, injury, infection – an otherwise “unexplained” high glucose reading may be a sign of onset of illness. Stress- worrying over a test or other personal or family issue may affect blood sugar. Hormone fluctuations, including menstrual periods and puberty. Other hormones, such as glucagon, growth hormone, adrenalin, cortisol or medications may affect blood glucose levels. To prevent increasing of blood glucose levels, action needs to be taken at the first signs of hyperglycemia, in accordance with the student’s DMMP. Not enough activity Illness, infection or stress KBN 2014

HYPERglycemia=High blood sugar Onset: Usually slow onset, not an emergency More rapid with: -pump failure/malfunction -illness -infection Can mimic flu-like symptoms Greatest danger: may lead to diabetic ketoacidosis (DKA) if not treated As previously stated hyperglycemia is a term that refers to high blood glucose level in the blood. Yet the irony is that with all the glucose floating around in the blood the body cells are actually starving because glucose cannot get in. An isolated high blood glucose reading is cause for concern, but not alarm. For example, blood glucose is expected to be somewhat higher following a meal or snack, but it should also drop once insulin starts to work. However, it is also important to note that hyperglycemia can occur more rapidly in students with insulin pumps if a pump malfunctions or delivers less insulin. Illness or infection can also contribute to a more rapid escalation of hyperglycemia. Hyperglycemia becomes an increasing concern when several consecutive readings have been high, or when accompanied by vomiting. As hyperglycemia progresses, the student may be nauseous or be dehydrated and listless – often it looks “flu-like.” Any student with diabetes who presents with flu- like symptoms should immediately perform a blood glucose check, contact the school nurse and/or parent/guardian as directed by the student’s DMMP. Hyperglycemia most often does not appear to be as dramatic as does low blood glucose – so it is perceived as less threatening. Yet untreated, high blood glucose presents a much greater threat, especially for those students who are dependent on insulin. If there is not enough insulin for any reason - pump malfunction, failure to take insulin or insulin not working effectively - there may be a breakdown in fat, causing ketones to form, ketones may build up in the blood and may result in diabetic ketoacidosis (DKA). Fortunately, the onset of hyperglycemia and progression to DKA is usually slow. The student’s DMMP should determine precisely what actions should be taken at each level of severity of hyperglycemia. KBN 2014

HYPERglycemia-HIGH Blood Sugar HYPERglycemia alone is not an emergency When accompanied with nausea, vomiting and/or ketones, it does become an emergency and the school nurse and parent/ guardian should be called If unable to reach a parent or guardian, the school nurse should initiate contact with the health care provider or 911. KBN 2014

HYPERglycemia-HIGH blood sugar Common Symptoms Blurred Vision Thirsty These symptoms vary somewhat from individual to individual, or from episode to episode and can include: Thirst Blurred vision Lack of concentration Weight loss Frequent urination Sweet, fruity breath Fatigue/sleepiness Stomach pains Increased hunger Flushing of skin The important thing to remember is that intervention may prevent progression to more severe symptoms. Tired Hunger Frequent restroom breaks KBN 2014

HYPERglycemia-HIGH blood sugar other symptoms Headache Stomach pains Weight Loss Irritable Flushed Face Sleepiness/Fatigue Dry Mouth Nausea Confusion Labored breathing Profound weakness Unconscious Above target range More common symptoms of hyperglycemia. From confusion to unconsciousness is a slow progression that can take days. KBN 2014

HYPERglycemia: What to do Goal is to lower the blood sugar to target range by following the actions on the DMMP: Verify by blood sugar check Check urine ketones as ordered on DMMP Allow free use of restroom and access to water Contact school nurse to discuss plan of action. Administer insulin based on school nurse consult and DMMP School nurse/school employee will contact parent/guardian, especially if ketones are present. Recheck blood sugar per DMMP Document, noting any patterns or irregularities The goal in the treatment of hyperglycemia is to lower the blood glucose level to within a student’s target range. Always follow the individual student’s DMMP. Generally, the action steps for hyperglycemia are: First of all, verify status with a blood glucose check as specified in the DMMP. Secondly, check ketones as specified in the DMMP. Allow free use of bathroom and access to water Contact school nurse to discuss plan of action. Administer insulin based on consult with school nurse and as specified in the DMMP. Recheck blood glucose per DMMP. The school nurse will notify the parent/guardian . Note patterns and document accordingly. KBN 2014

HYPERglycemia: Risks and Complications Interferes with student’s ability to learn and participate Serious long-term complications develop when blood sugar levels remain above the target range over time and are recurring Hyperglycemia and ketones untreated can lead to diabetic ketoacidosis (DKA) and potentially to coma and/or death There are several important reasons to learn the signs, treatment, and prevention strategies for hyperglycemia. Remember hyperglycemia alone is not a medical emergency, hyperglycemia and ketones can lead to DKA so prompt treatment is imperative. If left untreated for an extended period, hyperglycemia resulting from insufficient insulin can lead to “diabetic ketoacidosis” (DKA) and/or coma and death. The onset is more rapid for students who wear insulin pumps. High blood glucose can affect a student’s general well-being. Students who do not feel well are less able to learn and participate in school activities. When glucose levels remain high over time or are recurring, serious life-limiting complications of diabetes develop. Diabetes is the leading cause of adult blindness, lower limb amputations, kidney failure, heart disease and stroke. Many students with diabetes will not experience symptoms from high glucose levels until the level is far above target range. Therefore, glucose testing is needed to identify otherwise undetectable high glucose levels. The good news is that, treating high glucose levels in accordance with the student’s DMMP, enables students to participate fully in their education and enhances their health and well-being in the future.   KBN 2014

GO TO THE AMERICAN DIABETES ASSOCIATION SAFE AT SCHOOLS VIDEO CHAPTER 4 HYPERGLYCEMIA on the internet at YOU TUBE: http://www.youtube.com/watch?v=i26P860R1AU&list=PL3DE9DDE8EB2A2E56&index=5 KBN 2014