1. HYPOGLYCEMIA/GLUCAGON®
Jennifer Sellers, RN,CDE
ACH Diabetes Team

2. Child will be testing blood sugars:
Blood Glucose Testing
Child 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)

3. 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

4. Target Blood Sugar Ranges
Below age 5 years:
mg/dl
5-12 years:
mg/dl
Teenagers:
mg/dl

5. The most common reasons for hypoglycemia
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

6. Symptoms of Hypoglycemia
headache
irritability
confusion
sweating
weakness
rapid heart rate
shakiness
personality changes

7. Treatment of Hypoglycemia
Treat any blood sugar below 70, using Rule of 15
For seizure or unconsciousness, use Glucagon Emergency Kit® as prescribed

8. 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.

9. Rule of 15: Insulin Pumps For blood sugar 51-70:
Follow Rule of 15
For blood sugar <50:
Start temporary basal (5% or –95%, depending on the pump), for 30 minutes
Give 30 grams of fast-acting carbs
Recheck in 15 minutes and continue with Rule of 15, if not >70

10. Examples of 15 gm Fast Acting Carbohydrate
4 ounces juice or regular soda
3 glucose tablets
2 pkg Smarties®
1 tube glucose gel
1 tube cake icing gel
3 sugar packets

11. What NOT to use to treat low blood sugar…

12. 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

13. 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

14. Glucagon®/Glucagen®

15. Glucagon Emergency Kit®

16. 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

17. REMEMBER
YOU CANNOT OVERDOSE
GLUCAGON®

18. 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

19. Case Scenario 1
Student 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?

20. Case Scenario 1 (cont.) Check blood sugar Follow Rule of 15
Recheck 75
Send to lunch, carbs eaten 48 grams with orders for 1:20 gms
48/20 = 2.4 = 2 units
Dose for all carbs eaten at lunch

21. 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…

22. Case Scenario 2 (cont.) Check blood sugar Follow Rule of 15 Repeat
The student has 2 more class periods until lunch…

23. 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.

24. Case Scenario 3
You are called to the classroom to find a student with diabetes having a seizure. How do you proceed?

25. 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

26. QUESTIONS

27. Resources American Diabetes Association, www.diabetes.org
Children with Diabetes,
Juvenile Diabetes and Research Foundation,
National Diabetes Education Program