MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA

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MANAGING HYPOGLYCEMIA AND HYPERGLYCEMIA
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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
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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

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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.

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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

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HypoglycemiaRisks Complications

• Greatest immediate danger
• Not always preventable
• Impairs cognitive and motor functioning
• Early recognition and intervention can prevent an
  emergency

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Hypoglycemia Possible Causes

• Too much insulin
• Too little food or delayed meal or snack
• Extra physical activity
• Illness
• Medications

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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
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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

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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

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Severe Hypoglycemia Symptoms

• Convulsions (seizures)
• Loss of consciousness
• Inability to swallow

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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.

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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

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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.

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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.

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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

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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.

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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

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Hyperglycemia Possible Signs Symptoms
Severe Symptoms Severe Symptoms
Labored breathing Confused Very weak Unconscious Labored breathing Confused Very weak Unconscious

Moderate Symptoms Moderate 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
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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.

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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.

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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.

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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.

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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.