TLCDBU-2016: Barb Schreiner

1. Managing diabetes chaos and
other emergencies
Barb Schreiner, PhD, APRN, CDE
2016 TLC Spring retreat

2. Navigate a diabetes emergency
• Correct the blood glucose
• Chase down the cause
• Consider what you learned
2016 TLC Spring retreat

3. Ketones
• Where do ketones come from?
• What ketones tell you

4. Ways to measure ketones

5. Precision Xtra® meter
NovaMax® Plus meter
Ways to measure ketones
Blood
(mmol/L)
Urine
0.6 or lower Negative
0.6 to 1.5 Small to
Moderate
1.6 to 3.0 Moderate to
Large
3.0 or higher Very Large

6. High BG, ketones, sick days
• 2 key concepts: fluids and insulin
• Fluid management
• Insulin adjustments
2016 TLC Spring retreat

7. Time Blood glucose Ketones
Urine (blood)
What to do ?
7 AM 450 Large (2.2)
9 AM 380 Large (2.2)
12 N 350 Moderate (1.5)
2 PM 260 Moderate (1.6)
4 PM 346 Small (1.0)
6 PM 230 Moderate (1.5)
9 PM 180 Moderate (1.5)
2016 TLC Spring retreat

8. 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
2016 TLC Spring retreat

9. 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)
2016 TLC Spring retreat

10. 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)
2016 TLC Spring retreat

11. 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?
2016 TLC Spring retreat

12. 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
2016 TLC Spring retreat

13. Why are levels out of target?
• Insulin
• Sites
• Growth
• Hypo
• Ketones
• Exercise
• Diet
• Life
• Technical
2016 TLC Spring retreat

14. Managing diabetes chaos and
other emergencies
Barb Schreiner, PhD, APRN, CDE
2016 TLC Spring retreat