Sailing Around Common Diabetes Emergencies

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This presentation is authored by my good friend and colleague, Dr. Barb Schreiner. The presentation is for the Advanced Diabetes Seminar presented at Texas Lions Camp, Saturday, April 26, 2014.

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Sailing Around Common Diabetes Emergencies

  1. 1. Sailing around common diabetes emergencies Barb Schreiner, PhD, APRN, CDE
  2. 2. Navigate a diabetes emergency • Correct the blood glucose • Chase down the cause • Consider what you learned
  3. 3. High BG, ketones, sick days • 2 key concepts: fluids and insulin • What ketones tell you • Fluid management • Insulin adjustments
  4. 4. Time Blood glucose Ketones What to do ? 7 AM 450 Large 9 AM 380 Large 12 N 350 Moderate 2 PM 260 Moderate 4 PM 346 Small 6 PM 230 Moderate 9 PM 180 Moderate
  5. 5. When would you call the diabetes team? Yes No, not yet Situation Gave 3 extra doses and child no better (still sleepy and won’t drink) Gave 2 extra doses, child drinking and eating well, ketones coming down Fever, won’t drink Breathing hard, looks sick Sore throat, blood glucose high but no ketones BG high, no ketones, gave usual AM dose, now child won't eat Child vomited twice, BG normal, small ketones, due for supper dose
  6. 6. Mini Dose Glucagon Rescue for hypoglycemia during illness • Check with your diabetes team • Use for: – BG less than 80 AND – Stomach illness with nausea or vomiting Age Initial Dose (glucagon drawn with an insulin syringe) 2 years and younger 2 units (20 mcg) 2 to 15 years old 1 unit (10 mcg) for year of age 15 and older 15 units (150 mcg)
  7. 7. Mini Dose Glucagon Rescue for hypoglycemia during illness • BG may rise 60-90 mg/dl; last about one hour. • When to repeat • How to store unused Age Initial Dose (glucagon drawn with an insulin syringe) 2 years and younger 2 units (20 mcg) 2 to 15 years old 1 unit (10 mcg) for year of age 15 and older 15 units (150 mcg)
  8. 8. Finding patterns in the chaos • What are your BG goals? • When are BG levels out of target? • Why are the BG levels out of target? • How will you bring the BG levels back into target?
  9. 9. When are levels out of target Brk Lu Su Brk AA BB CC DD EE FF Brk Lu Su Brk AA BB CC DD EE FF Brk Lu Su Brk AA BB CC DD EE FF
  10. 10. Why are levels out of target? • Insulin • Sites • Growth • Hypo • Ketones • Exercise • Diet • Life • Technical

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