Child Care Diabetes Medical Management Plan Page 2
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1
2Managing Very Low Blood Glucose
Diabetes Dictionary
Hypoglycemia Plan for Blood Glucose less than
Blood glucose - The main sugar found in the blood and the
body’s main source of energy. Also called blood sugar. The blood
______________ mg/dL
glucose level is the amount of glucose in a given amount of blood.
It is noted in milligrams in a deciliter, or mg/dL.
1. Give 15 grams of fast acting carbohydrate.
Bolus - An extra amount of insulin taken to lower the blood
2. Recheck blood glucose in 15 minutes.
glucose or cover a meal or snack.
3. If still below 70 mg/dL, offer 15 grams of fast acting
Bolus calculator – A feature of the insulin pump that uses input
carbohydrate, check again in 15 minutes.
from a pump user to calculate the insulin dose. The user inputs the
blood glucose and amount of carbohydrate to be consumed, and
4. When the child’s blood glucose is over 70, provide 15g of
the pump calculates the dose that can be approved by the user.
carbohydrate as snack. Do not give insulin with this snack.
Correction Factor – The drop in blood glucose level, measured
5. Contact the parent/guardian any time blood glucose is
in milligrams per deciliter (mg/dl), caused by each unit of insulin
less than ________ mg/dL at child care.
taken. Also called insulin sensitivity factor.
Usual symptoms of hypoglycemia for this child include:
Diabetic Ketoacidosis (DKA) – An emergency condition caused
by a severe lack of insulin, that results in the breakdown of body
Shaky
Fast heartbeat
Sweating
fat for energy and an accumulation of ketones in the blood and
Anxious
Hungry
Weakness/Fatigue
urine. Signs of DKA are nausea and vomiting, stomach pain, fruity
Headache
Blurry vision
Irritable/Grouchy
breath odor and rapid breathing. Untreated DKA can lead to coma
and death.
Dizzy
Other __________________________
Fixed dose regimen – Children with diabetes who use a fixed
1. If you suspect low blood glucose, check blood glucose!
dose regimen take the same “fixed” doses of insulin at specific
times each day. They may also take additional insulin to correct
2. If blood glucose is below ________, follow the plan above.
hyperglycemia.
3. If the child is unconscious, having a seizure (convulsion) or
Glucagon – A hormone produced in the pancreas that raises
unable to swallow:
blood glucose. An injectable form of glucagon, available by
prescription, is used to treat severe hypoglycemia or severely low
the first hash mark on the syringe. Then inject into the
blood glucose.
thigh. Turn child on side as vomiting may occur.
Hyperglycemia - Excessive blood glucose, greater than 240 mg/
dL for children using and insulin pump and greater than 300 mg/
dL for children on insulin injections. If untreated, the patient is at
911 (or other emergency assistance). After calling 911,
risk for diabetic ketoacidosis (DKA).
contact the parents/guardian. If unable to reach parent,
Hypoglycemia - A condition that occurs when the blood
contact diabetes care provider.
glucose is lower than normal, usually less than 70 mg/dL. Signs
include hunger, nervousness, shakiness, perspiration, dizziness
Managing Very High Blood Glucose
or light-headedness, sleepiness, and confusion. If left untreated,
hypoglycemia may lead to unconsciousness.
Insulin - A hormone that helps the body use glucose for energy.
Hyperglycemia Plan for Blood Glucose higher
The beta cells of the pancreas make insulin. When the body
than ______________ mg/dL
cannot make enough insulin, it is taken by injection or through use
of an insulin pump.
Usual symptoms of hyperglycemia for this child include:
Insulin Pump - An insulin-delivering device about the size of a
Extreme thirst
Very wet diapers, accidents
deck of cards that can be worn on a belt or kept in a pocket. An
insulin pump connects to narrow, flexible plastic tubing that ends
Hungry
Warm, dry, flushed skin
Tired or drowsy
with a needle inserted just under the skin. Pump users program
Headache
Blurry vision
Vomiting**
the pump to give a steady trickle or constant (basal) amount of
Fruity breath
Rapid, shallow breathing
insulin continuously throughout the day. Then, users set the pump
to release bolus doses of insulin at meals and at times when blood
Abdominal pain
Unsteady walk (more than typical)
glucose is expected to be higher. This is based on programming
**If child is vomiting, contact parents immediately
done by the user.
Treatment of hyperglycemia/very high blood glucose:
Ketones - A chemical produced when there is a shortage of insulin
in the blood and the body breaks down body fat for energy. High
1. Check for ketones in the:
levels of ketones can lead to diabetic ketoacidosis and coma.
urine
blood (parent will provide training)
Multiple Daily Injection Regimen - Multiple daily insulin regimens
2. If ketones are moderate or large, contact parent. If
typically include a basal, or long acting, insulin given once per
unable to reach parent, contact diabetes care provider for
day. A short acting insulin is given by injection with meals and to
correct hyperglycemia, or elevated blood glucose, multiple times
additional instructions.
each day.
Contact parent if ketones are trace or small:
Yes
No
Type 1 Diabetes - Occurs when the body’s immune system attacks
the insulin-producing beta cells in the pancreas and destroys
insulin if the last dose of insulin was given 3 or more
them. The pancreas then produces little or no insulin. Type 1
diabetes develops most often in young people but can appear in
hours earlier. Consult the insulin plan above for
adults. It is one of the most common chronic diseases diagnosed
instructions. If still uncertain how to manage high blood
in childhood.
glucose, contact the parent.
4. Provide sugar free fluids as tolerated.
_____________________________________________________________________
5. You may also:
Physician Signature
Provide carbohydrate free snacks if hungry
Delay exercise
to the bathroom
Stay with the child
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