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MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA

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Title: MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA


1
MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA
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.
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
HypoglycemiaRisks 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
Sleepiness
Hunger
Changed behavior
Shakiness
Sweating
Weakness
Anxiety
Paleness
Dilated pupils
Blurry vision
Increased heart rate/palpitations
Moderate to Severe Symptoms
Confusion
Yawning
Restlessness
Irritability/frustration
Dazed appearance
Extreme tiredness/fatigue
Unconsciousness/coma
Inability to swallow
Seizures
Sudden crying
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
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 students DMMP.
  • Never attempt to give food or put anything in the
    students 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 students 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.
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