With Glucagon Training for School Staff

Goals for today

Understand what diabetes is. Recognize a hypoglycemic reaction. Understand the intended purpose and the side effects of a glucagon injection. Be able to draw up and inject glucagon as needed.

Overall Goal: Optimal Student Health and Learning

Monitoring Blood Glucose

Hypoglycemia & Hyperglycemi a

Ketones Legal Rights

Glucagon
Administration

Health & Learning

Administration

Insulin

Exercise
Nutrition

Knowing about glucagon administration is critical to student success. But just one piece of a comprehensive management plan.

What is Diabetes
Diabetes is a condition in which the body cannot use or does not produce enough insulin. Without insulin, the body cannot get the blood glucose (that is the result of food digestion) into the cells for energy.

Without Insulin
Eat Blood Glucose Goes Higher Eat No Blood Glucose In Cells Eat Blood Glucose Goes Higher

The blood glucose cannot get into the cells to provide energy without insulin. Without insulin high levels of blood glucose build up in the blood causing hyperglycemia aka high blood sugar.

Hyperglycemia

HYPERGLYCEMIA
Signs and symptoms
Frequent urination Increased hunger Fatigue/weakness Weight loss Blurry vision Fast, deep breathing Increased thirst Slow or confused thinking

Blood glucose checking

Daily blood glucose checking is an important part of diabetes control. Blood glucose checks are usually done before meals, at bedtime, and with exercise. When in doubt, CHECK the blood glucose if the student is not feeling well or is complaining of feeling low.

Insulin
Insulin is a hormone secreted by the pancreas. With diabetes it must be given as an injection. The dose will vary with the blood glucose level, food intake and exercise.

Insulin should
Lower the blood glucose. Facilitate the blood glucose getting into the cells to provide energy.

Exercise
When the student exercises, the body uses the blood glucose more effectively, which can lead to low blood glucose

(hypoglycemia).
Stress and illness may also effect blood glucose level.

Insulin can cause blood glucose to fall too low when:

Too much insulin is given. Not enough food is eaten. Too much exercise.

This is called hypoglycemia

Hypoglycemia can be life threatening if not treated because the only energy source for the brain is blood glucose.

Symptoms of hypoglycemia
Pale Shaky Hunger Headache Tingling Mood Change Sleepiness Sweating Dark eyes

Symptoms can progress to:

Confusion Blurred Vision

Late stages of hypoglycemia may include:

Coma Seizure Death

Hypoglycemia Treatment for a conscious person:

If you can, check the blood glucose. If it is below 70 mg/dL, treat as a hypoglycemic reaction.

When in doubt or unable to check the blood glucose, treat as a hypoglycemic reaction.

Give a drink high in sugar 6oz. of regular soda pop (not diet), 4-6 ounces of fruit juice 3-4 glucose tablets Follow with a milk and protein or send them to lunch if they can eat within 10 to 15 minutes

Stay with the child!

You should see a response within 15 -20 minutes. You can repeat the treatment in 15 minutes if symptoms are still present or if they become worse.

Hypoglycemia Treatment with

decreased awareness
If the student is still able to chew and swallow without difficulty you may give glucose gels and/or tablets to treat hypoglycemia. Gels are placed in the students mouth toward the cheek and back teeth.
Examples: Glucose tablets, Dextrose tablets, Gel frosting or honey. Do not attempt to give a child with significantly decreased cognitive awareness anything to eat or drink as they are at risk for choking.

Glucagon
Lilly Glucagon Emergency Kit

Novo Nordisk GlucoGen HypoKit

What Is Glucagon?
Naturally occurring hormone made in the pancreas. A life-saving, injectable hormone that raises blood glucose level by stimulating the liver to release stored glucose. Treatment for severe hypoglycemia.

Can save a life.

Cannot harm a student cannot overdose.

Liver

Pancreas

We recommend glucagon be stored in an unlocked cabinet at

the front office however, some students may prefer to carry their glucagon. Store at room temperature Expiration date: Monitor After mixing use immediately Please refer to the students Individualized Health Care Plan and physicians orders.

Emergency Kit Contents:

1 mg of freeze-dried glucagon (Vial) 1 ml of water for reconstitution (Syringe)

Combine immediately before use

When to Give Glucagon If authorized by the students Health Care Plan/504 and if student exhibits:
Unconsciousness, unresponsiveness Convulsions (seizures) Inability to safely eat or drink

Treatment for an unconscious student:

Identify someone to call 911

Identify someone to get Glucagon

Turn student on their side Administer Glucagon

Call the parent

Stay with the student and watch for signs and symptoms of adverse reactions

Do not recap needle, place syringe in kit box

Send Glucagon with EMS

Glucagon Adverse Reactions

The most common side effects are nausea and vomiting. These reactions may also occur with hypoglycemia. Keep the student positioned on his or her side.

After Injecting Glucagon

May take 10-20 minutes for student to regain consciousness. Check blood sugar. Give sips of fruit juice or regular soda, once student is awake and able to drink. Advance diet as tolerated. Document as per Health Care Plan or 504

Don't Be Surprised If. . .

Student does not remember being unconscious, incoherent or has a headache. Blood sugar becomes very high (over 200).

Nausea or vomiting occurs.

Why has this become necessary

The goal of diabetes care is to keep the blood glucose closer to normal. Despite best efforts hypoglycemia will occur.
Glucagon is the fastest means to raise the blood glucose level.

Considerations
The time to complete recovery from a severe hypoglycemic episode varies according to how low the blood glucose level was and for how long prior to treatment.
A seizure may occur even if the blood sugar is within the target range if it drops precipitously and a lot. Some signs and symptoms, such as headache, may persist for several hours, although the blood sugar level is satisfactory. Continued monitoring is important.

THE LAW

53A-11-603
CARE OF STUDENTS WITH DIABETES IN SCHOOL
A public school shall, within a reasonable time after receiving a glucagon

authorization, train two or more school personnel who volunteer to be

trained in the administration of glucagon, with training provided by the school nurse or another qualified licensed medical professional. School personnel who provide or receive training under this section and act in good faith are not liable in any civil or criminal action for any act taken or not taken under the authority of this section with respect to the administration of glucagon.

Information Adapted from the American Diabetes Association