1. Diabetes Care Tasks at School: What Key Personnel Need to Know Diabetes Care Tasks at School: What Key Personnel Need to Know MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA

2. 2 Overall goal: Optimal student health and learning Managing hypoglycemia and hyperglycemia are critical to student success. But just one piece of a comprehensive management plan. Exercise Legal Rights Health & Learning Nutrition Insulin Administration Hypoglycemia & Hyperglycemia Ketones Monitoring Blood Glucose Glucagon Administration

3. 3 Learning Objectives Participants will learn : 4 Symptoms of high and low blood glucose 4 Short- and long-term risks 4 Treatment of high and low blood glucose 4 Prevention of high and low blood glucose

4. 4 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 pre- measured 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.

5. 5 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

6. 6 Hypoglycemia:Risks & Complications Greatest immediate danger Not always preventable Impairs cognitive and motor functioning Early recognition and intervention can prevent an emergency

7. 7 Hypoglycemia: Possible Causes Too much insulin Too little food or delayed meal or snack Extra physical activity Illness Medications

8. 8 Dilated pupils Anxiety Sweating SeizuresSudden crying Unconsciousness/comaInability to swallow Dazed appearanceExtreme tiredness/fatigue RestlessnessIrritability/frustration ConfusionYawning Moderate to Severe Symptoms Increased heart rate/palpitations Blurry vision Paleness Weakness Changed behaviorShakiness SleepinessHunger Mild Symptoms Hypoglycemia: Possible Signs & Symptoms

9. 9 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

10. 10 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

11. 11 Severe Hypoglycemia Symptoms Convulsions (seizures) Loss of consciousness Inability to swallow

12. 12 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.

13. 13 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

14. 14 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.

15. 15 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.

16. 16 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

17. 17 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.

18. 18 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 Hyperglycemia: Possible Causes

19. 19 Severe Symptoms Labored breathing Confused Very weak Unconscious Moderate Symptoms Hyperglycemia: Possible Signs &Symptoms Frequent urination Blurred vision Flushing of skin Increased hunger Fatigue/sleepiness Stomach pains Sweet, fruity breath Weight loss Dry mouth Vomiting Stomach cramps Nausea Mild Symptoms Lack of concentration Thirst

20. 20 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.

21. 21 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.

22. 22 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.

23. 23 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.

24. 24 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.