1. Diabetes in Schools Reviewing the New Laws Diane Stewart APN-C, CDE

2. Blood Sugar less than : a. 90mg/dl for less than 5 years of age b. 80 mg/dl for 5-11 years old c. 70 mg/dl for 12 years and above

3. What Causes It? Too much insulin Not enough food Exercise – can lower blood sugar up to 12 to 18 hours after the exercise

4. Symptoms:

5. How to treat hypoglycemia 1 Test blood sugar If blood sugar is low- treat with 15 grams of carbohydrate – 4 ounces juice apple or orange – 3 square glucose tablets (not being made any more) – 4 round glucose tablets

6. Note: If blood sugar is 50 mg/dl or less Start with 30 grams of carbohydrates 8 ounces of juice 10 ounces of regular soda

7. Recheck blood sugar in 15 minutes If the blood sugar is still too low 1. Give another 15 grams of carbohydrates 2. Wait another 15 minutes 3. Recheck Blood sugar How to treat hypoglycemia 2

8. How to treat hypoglycemia 3 Once it is back in the normal range: if it is NOT time for a meal, give a snack with protein or fat - OR - if it IS time for a meal let them eat the meal. If the blood sugar is still high 60’s subtract 15 grams of carbs when calculating the dose

9. Unconscious Hypoglycemia DO NOT inject insulin. DO NOT provide food or fluids. DO NOT put hands/fingers in their mouth. DO inject glucagon. DO call for emergency help.

10. Emergency Kits

11. Dosage: Under 100 pounds – give 0.5 or half Over 100 pounds – give full dose 1 mg glucagon forces the liver to release glucose into the bloodstream. It takes approximately 5 to 15 minutes for the glucagon to work in a diabetic person with low blood sugar. diabetic person

12. Important!! If you give too much glucagon to a child – you will not harm them. Blood sugar will stay elevated longer They may have more nausea and vomiting These will subside This is safer than the hypoglycemia

13. Hypoglycemia Unawareness Hypoglycemia unawareness is when you lose consciousness without ever knowing your blood glucose level was dropping or showing other symptoms of hypoglycemia Usually seen when hypoglycemia is not treated quickly on a regular basis. Lack of prompt treatment causes the symptoms of hypoglycemia to gradually disappear.

14. HyperglycemiaHyperglycemia (high blood sugar)

15. Blood sugars can be high for several reasons: –If you eat or drink something and do not give enough rapid acting insulin or miss a shot –When you get sick or stressed your body’s natural response can cause blood sugars to rise. Whenever your sugar is above 240 you should check for urine ketones

16. When there is not enough insulin present, sugar cannot be used as fuel so the body makes ketones, by breaking down fat, which do not need insulin to be used by the body. A high level of ketones can cause a high acid level in the blood which is bad for the body’s other organs such as the heart. Therefore it is very important to know when to check for ketones and what do to when you have them.

17. Ketone Production Cycle Cells are starving Body needs another fuel Liver makes ketones to feed the cells Not enough insulin Sugar stays in bloodstream

18. Ketone Production Cycle Symptoms: nauseas confused breath smells like alcohol breathing becomes fast Acid levels in the blood rise which can be dangerous!!!! Ketone levels get higher

19. Treatment of Hyperglycemia : If symptoms noted, check blood sugar If blood sugar greater than or equal to 240 mg/dl, check urine for ketones Dip ketone test strip into urine – wait 15 seconds and match color

20. If result is moderate or large 1. Call doctor Have child drink 1-2 cups of water every hour Recheck urine for ketones with next void

21. If child is vomiting with moderate or large Ketones – they should go to an emergency room. It is important to call the MD if moderate or large ketones are present as the insulin correction dosages will not be enough to stop this process.

22. Snacking Depends on insulin regime Basal/Bolus Regime – 1. does not need a snack if the dosages are correct If snack is taken, give insulin according to the carbohydrate count

23. NPH or Mixed Insulin Regimes May need a mid-morning or afternoon snack to prevent hypoglycemia Snacks should be 15-30 grams of carbohydrates Note: may need extra snacks if meal intake of carbohydrates was less than recommended amount

24. Diabetes & Eating Disorders Seen more due to: 1.Rigid dietary regimes 2.Heightened emphasis on food 3.Weight gain that occurs with the onset of insulin treatment 4.Body image concerns and a strong preference for thinness as the “ideal” body type among adolescent females

25. Behaviors Noted: 1. manipulation and withholding of insulin to produce glycosuria and weight loss 2. use of control solution or other fluids instead of blood when checking blood sugar 3. leaving hands wet to dilute blood and show lower BS reading 4. taking needle out to soon to obtain leakage of insulin on skin

26. Complications 1. more frequent diabetic ketoacidosis 2. earlier onset of diabetic complications 3. increase in retinopathy, neuropathy and nephropathy 4. more rapid progression of complications – microvascular, macrovascular, and psychological