• Glucagon emergency kit
• Cake Decorating Gel
• Winkies

Emergency Information

1. Call emergency numbers listed. If no one is available and he/she has not regained consciousness.
2. Call Hatzolah at (718) or (212) 230-1000, 387-1750 or 911 and state that you need a paramedic.
3. Cake/glucose gel should be used for low blood sugar with consciousness but not alert enough to take Winkies on his own. Rub cake gel on the upper palette, cheeks and/or gums. (Details below)
4. Winkies- is what he/she uses on their own to raise his/her low blood sugars.
5. Winkies and testing kit must be on his/her possession at all times.
6. He/she wears a medic-alert necklace or bracelet and carries a medic-alert card with emergency numbers.

Blood Glucose Testing

• Anytime he/she feels low or uncomfortable
• Before meals
• Before/after exercise-with strenuous exercise test 1 hour later as well
• When running --> 240 he should test every hour or two
• 10-15 minutes and 1hour after having a low blood sugar
   

Low Blood Sugars

Mild low blood sugar between 50-70mg/dl

• Change in personality
• Acting quiet and withdrawn
• Acting stubborn or restless
• Tantrums or sudden rage
• Confusion-difficulty in forming words or sentences
• Inappropriate emotional response ex: laughter, crying
• Poor concentration or daydreaming
• Shakiness, Headache, Extreme hunger Sweatiness, and/or increased heart rate.
   

A low blood sugar can become very dangerous therefore:
If any of the above or other unusual symptoms is present the child should be asked to test and show the number.
If he/she is not responding to this request and is symptomatic they must be tested immediately.
If in doubt always treat for a low and confirm afterwards.
Never send a child suspected of a low to the Nurses or Principal’s office on their own. If needed, send another student to get help.

If blood glucose 80 and child is feeling better they can return to class Test again after15-20 minutes.

High Blood Sugar --> 240 symptoms:

• Staggering walk
• Loss of appetite
• Inattentiveness
• Increased thirst
• Rapid breathing
• Tiredness, sleepiness
• Fruity odor to breadth
• Nausea and/or vomiting
• Frequent urination

With any of these symptoms present or any unusual behavior, have the child test. If BGs are above 240 mg/dl he/she must check for ketones

• Give lots of fluids (sugar free) water or diet soda
• Recheck blood and urine in 1-2 hours

• Insulin may need to be given, call parent or medical help
• Encourage drinking

Pumpers

The pump is a continuous delivery system with Humalog/Novolog insulin. It needs to be connected at all times. The maximum time off the pump is 1 hour once a day. It should never be disconnected without prior approval from a parent or doctor. A Bolus (using the pump to deliver extra insulin) is taken before eating E.g. 1 unit for every 10 grams of carbohydrate (calculated to the nearest .5 of a unit) Please remind him/her to bolus before eating. (Each individual has his/her calculations specified by one of the child’s health care team).

1 unit for every 6 points (1 unit for every 60 points) over 120

Corrections should only be made once every 4 hours and only if BGs are --> 150. If --> 240 for more than 3 hours for no apparent reason or if set comes out a new set should be put in right away. The insulin pump may give an error. It must be tended to right away. If the problem cannot be solved either call home or Pump’s 800 number (on the back of the pump).

If basal rates need adjusting there may be a need to test every hour during certain times of the day. A note will be sent in if/when this is necessary.

Supplies for schoolcontainer for used supplies should be kept in a closed locker or office, and emptied periodically

• Extra meter
• Test strips
• Replacement batteries
• Alcohol swabs
• Ketone test strips
• Syringes
• Winkies

For instruction on Insulin storage, follow guardian’s directions. If extra insulin is being kept in the school it should be refrigerated.

Pump Supplies

• Extra batteries,
• Extra reservoirs,
• Extra infusion sets,
• Tape and alcohol pads or preps