School Health Plan for Children on an Insulin Pump



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School Health Plan for Children on an Insulin Pump

Student:




DOB:




Grade:




School:




Physician/Phone:




Medications: Humalog insulin/Novolog insulin




Pump Type:




Infusion set type:




Parent/Guardian name(s):




Home Number:




Work Number:




Pager/Cell Phone:




Other Contact:




Health Concern: Insulin Dependent Diabetes




Date of Diagnosis:



Calculating a Meal or Snack Insulin Dose:



  • Check the current blood glucose level before the meal or snack, target range is 70-150

  • Enter the blood glucose value into the pump

  • Count the number of carbohydrates in the food about to be eaten

  • Enter the amount of carbohydrates into the pump

  • The pump will calculate the prescribed amount of insulin

  • Deliver the bolus dose by pressing the designated buttons on the pump

  • Do not administer more than 10 minutes before a meal

  • If blood sugar is less than 70 mg/dl, wait to give meal bolus until after meal

  • Basal rates are determined by healthcare providers and will not need to be adjusted




Time

Basal Rate












































































Start time

Carb to insulin ratios















































Start time

Blood Glucose Correction





















Low Blood Sugar (Hypoglycemia) - Below 70mg/dl
Causes:

  • Bolused too much insulin

  • Too few carbohydrates consumed for the amount of insulin given

  • Over-exercise or unusually high activity

  • High excitement

If you see this

Do this

Signs of Low Blood Sugar

  • Headache

  • Sweating, pale

  • Shakiness, dizziness

  • Tired, falling asleep in class

  • Inability to concentrate

  • Poor coordination

  • Other







  1. Have someone accompany student to nurse’s office or check in the classroom

  2. Check blood glucose.

  3. If less than 70mg/dl, give one of the following sources of sugar

  • 2-4 glucose tablets

  • 6-9 Sweetarts candies

  • 4-6 Lifesavers candies

  • 4-6 oz orange or other juice

  • 4-6 oz regular soda (not sugar-free)

  • Other




  1. After 15 minutes, check blood glucose again

  2. Retreat if necessary, until blood glucose is above 70

Signs of a low blood glucose – Moderate

  • Severe confusion

  1. Have someone accompany student to nurse’s office or treat in classroom

  2. Check blood glucose

  3. Keeping head elevated, give one of the following forms of sugar

  • 1 tube Cake Mate gel applied between cheek and gum

  • ½-1 tube instant glucose applied between cheek and gum

  1. May place pump in suspend or stop OR

Disconnect insulin pump at insertion site. Store pump in a safe place

  1. After 15 minutes, check blood glucose again

  2. Retreat if necessary, until blood glucose is above 70

  3. If blood glucose is stable(70-150), turn pump back on

  4. Notify parent/legal guardian

Signs of low blood glucose – SEVERE

  • Unconsciousness

  • Seizure

  1. Place student on side

  2. Call 911, then parent and physician

  3. Place pump in suspend or stop OR disconnect insulin pump at insertion site

  4. Remain with student until help arrives

  5. Pump needs to remain with the student if transported to hospital, ED, etc.

  6. If personnel are authorized to use Glucagon

give prescribed dose:




cc





High Blood Sugar (Hyperglycemia)
Causes:

  • Illness

  • Underestimated carbohydrates and bolus

  • Pump cartridge is empty

  • Cannula is kinked under the skin

  • Infusion set and site has exceed 72 hours

  • Insulin pump malfunction regarding delivery

  • Leak in the infusion set tubing

  • Increased stress

  • Excessive exercise without proper insulin

  • Ineffective insulin pump

  • Dead battery – no insulin delivery


If you see this


Do This

Signs of High Blood Sugar


  • Excessive thirst

  • Frequent urination

  • Hunger

  • Nausea, vomiting

  • Hyperactivity

  • Headache

  • Other







Immediate Action

  1. Accompany student to nurse’s office

  2. Check the student’s blood glucose

High Blood glucose levels


Treatment for High Blood Sugar Levels

If the Blood sugar is 150 – 250:

  1. Give the correction bolus

  2. Recheck the blood glucose in 2 hours, re-bolus if necessary

If the Blood sugar is >250:

  1. Check urine or blood ketones (see following page)

  2. If ketones are negative, have the student give a correction bolus via the pump.

  3. If ketones are positive, give the correction bolus via injection.

  4. Recheck blood glucose and urine/blood ketones every 2 hours

  5. Call the parents

If there are two consecutive unexplained blood sugar levels >250 with or without ketones:

  1. Give the correction bolus via injection

  2. May change the infusion set

  3. Call the parents

Checking Ketones



If you see this


Do this

Urine Ketones


  1. Completely cover the colored square on the

end of the strip by dipping into fresh urine.

  1. Immediately remove the strip from the

urine.

3. Gently tap the edge of the strip to remove

excess urine.


  1. Wait 15 seconds using the second hand on

a watch (if using Ketostix)

  1. Wait one minute if using the Chemstrip

uGK strip

  1. Compare the test area with the

corresponding color chart

8. Record the appropriate result




How to treat Urine Ketones

Ketones = Trace


  1. Have the student drink 8 oz of sugar free fluid every hour until ketone free.

  2. Call parents

Ketones = Trace – Small


  1. Have the student drink 8 oz of sugar free fluid every hour until ketone free.

  2. Recheck blood glucose in 2 hours or

  3. Recheck urine ketones in 2 hours

  4. If ketones are still present, call parents.

Ketones = Moderate – Large


  1. Call parent or health care provider for dosing instructions

  2. Administer correction bolus via injection

  3. Have the student drink 8 oz of sugar free fluid every hour until ketone free

4. May change the infusion set

Blood Ketones


How to check Blood Ketone using the Precision ketone test strips

  1. Obtain a blood sample from the finger

  2. Apply blood sample to the ketone electrode strip

  3. Apply enough blood to the strip to start the count down process

  4. A numeric value will appear at the end of the blood ketone testing process



Blood Ketone Chart

Below 0.6 mmol/l = negative ketones


  1. No action needed

0.6 to 1.5 mmol/l = Trace to Small ketones

  1. Have the student drink 8 oz of sugar free fluid every hour until ketone free.

  2. Recheck blood glucose in 2 hours or

  3. Recheck urine ketones in 2 hours

  4. If ketones are still present, call parents.

Above 1.5 mmol/l = Moderate to Large

ketones

  1. Call parent or health care provider for dosing instructions

  2. Administer correction bolus via injection

  3. Have the student drink 8 oz of sugar free fluid every hour until ketone free

4. May change the infusion set

Above 3.0 mmol/l = Contact parents or Health care provider. May need more intensive medical care



Pump Supplies


Supplies:

Needed

Not Needed

Blood glucose meter and blood glucose strips







Lancets with lancet device







Blood ketone strips (if using the Precision meter)







Urine ketone strips







Insulin syringes







Antibacterial skin cleanser or Alcohol wipes







Insulin pump cartridge/reservoir







Insulin pump infusion set







Transparent dressings







Insulin pump batteries







Quick-serter/Sof-serter/Sil-serter (if used)







Bottle of refrigerated quick acting insulin -

Humalog (Lispro)/Novolog (Aspart)









Pump alarm card







Glucose tabs, Cake Mate  gel , juice, or other source of glucose







Carbohydrate snack







Glucagon Emergency Kit  (if delegated by RN)







Pump manual







Sharps container







Copy of current basal rates and bolus dosing










Pump company name

24 Hour Help Phone number

MiniMed

1-800-826-2099

Deltec

1-800-426-2448

Disetronic

1-800-688-4578

Animas

1-877-767-7373

As parent/guardian of the above named student, I give my permission for use of this plan in my child’s school and for the school to contact the above named physician if necessary to complete the Health Care Plan.



















School Nurse

date




Parent

date
















Clinic Aide

date




Physician

date
















Principal

date




Reviewed

date

References:


Easy as ABC, Disetronic Medical System Inc, 2000.
Pumper in the School, MiniMed Inc., 2000



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