MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA

1. MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA

2. Hypoglycemia& Hyperglycemia Monitoring Blood Glucose Ketones Health & Learning Legal Rights Exercise Insulin Administration Nutrition 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. Glucagon Administration

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

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

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

8. Hypoglycemia:Possible Signs & Symptoms Mild Symptoms Hunger Sleepiness Shakiness Changed behavior Weakness Sweating Paleness Anxiety Blurry vision Dilated pupils Increased heart rate/palpitations Moderate to Severe Symptoms Yawning Confusion Irritability/frustration Restlessness Extreme tiredness/fatigue Dazed appearance Inability to swallow Unconsciousness/coma Sudden crying Seizures

9. Mild Hypoglycemia: What to do • Intervene promptly. Follow DMMP. • Verify with blood glucose test when available. • When in doubt, always treat.If no meteris 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. 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. Severe Hypoglycemia Symptoms • Convulsions (seizures) • Loss of consciousness • Inability to swallow

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. 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. 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. 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. 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. 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. Hyperglycemia:Possible Causes • 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

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

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. 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. 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. 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. 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.