This document provides information about diabetes and how to care for students with diabetes in schools. It discusses what diabetes is, signs and symptoms of low and high blood sugar, new laws regarding diabetes care in schools, what glucagon is and how it is used to treat severe low blood sugar, proper storage and administration of glucagon, and what to do after administering glucagon. The overall purpose is to educate about diabetes and establish protocols for providing care to students with diabetes in schools.

1. DIABETES-What You Need to Know

2. What is Diabetes Illness that prevents the body from using food properly Not enough insulin Body doesn’t use insulin properly Most children have Type 1 And use insulin injections

3. Signs and Symptoms of Low/High Blood Sugar Low-shaking, sweaty, irritable or anxious, headache, hunger, weakness and fatigue High-drowsiness, hunger, extreme thirst, frequent need to use the rest room Signs of either-child needs to check blood sugar Student specific health plan with more details provided if you have a diabetic student

4. New Diabetes Law Only if a written request is provided, the child may monitor his Diabetes in the classroom That includes checking the blood sugar and taking insulin (includes carrying syringes)

5. Glucagon A Diabetic student should carry Glucagon-injectable glucose used if blood sugar is too low If the student is self-managing, you may be asked to be a delegate to give the Glucagon, if the student can’t No one is required to be a delegate To be a delegate, you volunteer to the school nurse and you must be trained

6. What Is Glucagon? • Naturally-occurring hormone made in the pancreas Raises blood glucose level by stimulating the liver to release stored glucose Used to treat severe hypoglycemia/low blood Sugar Is life-saving, cannot overdose

7. Glucagon or GlucaGen Kit Storage Storage Locations should be included in student’s IHP/IEHP Store at room temperature Monitor expiration date After mixing, dispose of any unused portion within one After mixing, dispose of any unused portion within one hour

8. When to Give Glucagon/Glucagen If a student with diabetes exhibits: • Unconsciousness, unresponsiveness • Convulsions (seizures) • Inability to safely eat or drink

9. Procedure: Act Immediately The school nurse or trained delegate will: Assess: airway breathing circulation and Symptoms Administer glucagon in accordance with the student’s IHP/IEHP Position student safely on his side and monitor If you are the delegate, you must act and not wait for the nurse

10. If the responder is alone, call 911 then call for assistance from other school personnel. If others are immediately available, have them call 911 and contact the parents/guardians while the responder attends to the student. Procedure: Act Immediately

11. Preparation of Glucagon and Mixing Solution Remove flip-off seal from the glass vial containing dry powder. Remove needle protector from syringe. Put on gloves, if available. Inject entire fluid in syringe into the bottle containing the powder. Don’t take the syringe/needle out of the vial. Gently shake the vial in your hand until the powder has completely dissolved. The solution should be clear and colorless.

12. Dosing and Drawing Out Draw prescribed amount of glucagon back into syringe by pulling gently on the syringe plunger. The correct dosage is based on the child’s body weight. The correct dose can be taped inside the child’s kit for quick reference or on the label. Remove air from the syringe and tip of the needle.

13. Injecting Inject at 90° into the tissue on the upper arm, thigh, or buttock. Maintain the student’s privacy as much as possible.

14. After Injecting Apply light pressure at injection site and withdraw needle. Do not recap syringe. Discard needle/syringe in a medical waste container. Be sure student is positioned on side as vomiting may occur. It may take 10-20 minutes for student to regain consciousness. 14. Wait for EMS to arrive.

15. After Injecting Once student is awake and able to drink, give sips of fruit juice or regular soda. Document incident per district school health policy. Ensure that incidents that occur outside of the school day are recorded and submitted to the school nurse.

16. Don't Be Surprised If. . . Student does not remember being unconscious, incoherent or has a headache. The blood glucose level becomes very high(over 200). Nausea or vomiting occurs.