diabetes in young persons in elgin
HYPOGLYCAEMIA
At times your pupil may show signs of having too little glucose in their
blood. The term for this is hypoglycaemia or a ‘hypo’. This is a blood
glucose level of less than 4mmol/l. This may result from not enough
food i.e. missed or delayed meal or snack, or from extra exercise or
more activity than usual. Every child with diabetes will have hypos and
one or two a week is considered normal; any more and parents should
be contacted.
Children having a hypo may feel or look different from their normal,
however this may not always be the case. Symptoms may include:
Hunger
Pale/Sweaty
Feeling wobbly/shaky
Headache or Tummy ache
Difficulty concentrating
Grumpy
Tearful/Weepy
Feeling ‘not right’
Confusion/Aggression
The child may check their blood glucose level if they have any of these
symptoms or if in doubt should treat anyway.
They should never be left alone or sent unaccompanied to the medical
room, as they may become disorientated/unconscious if the blood
glucose level continues to drop,
If the child is primary school age, the parents will provide a box
containing everything necessary to treat a hypo. Academy age children
should carry their own supply of dextrose and an extra snack.
If your pupil becomes unwell at school please contact the parents or if
appropriate the diabetes team. The Diabetes Nurse Specialists can be
contacted on 01343 567469 or the medical ward on 01343 567579.
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diabetes in young persons in elgin
TREATING HYPOGLYCAEMIA:
Blood Glucose less than 4mmol/l
1 MILD HYPO 2 MODERATE HYPO 3 SEVERE HYPO
COOPERATIVE UNCOOPERATIVE UNCONSCIOUS
/SEIZURE
Give fast acting sugary Give glucagon injection as
carbohydrate i.e. Use glucogel rub into insides of instructed.
3-6 glucose tablets or cheeks a little at a time. This Under 8yrs give half
50mls original lucozade or can take 5-10 minutes to work. Over 8yrs give all
100mls coke (not diet) or This can be repeated if
100mls fresh fruit juice necessary.
Seek
Wait for around 5-10 minutes immediate
and if still feeling hypo repeat If gel given twice medical advice
sugary carbohydrate as or condition
above. becomes worse
After sugary carbohydrate consider giving
give slow acting glucagon injection
Carbohydrate snack i.e.
Sandwich
Banana
Digestive biscuits
Cereal bar Call Diabetes Nurses or
medical ward for advice
If no improvement after
3 sugary drinks treat as
moderate hypo.
Check blood glucose level an
hour or so later to ensure it
has not dropped low again.
Remember never to give any food, drinks or glucogel to an unconscious
child.
Useful telephone numbers:
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diabetes in young persons in elgin
HYPERGLYCAEMIA
At times the blood glucose may be too high. The term for this is
Hyperglycaemia – a blood glucose reading of greater than 15mmol/l.
This may be a short-term problem for example the child may have eaten
something sweet, or it may reflect a longer period of sub optimal
diabetes control. A child with high blood glucose readings may present
with the following symptoms:
Poor concentration
Excessive thirst – please do not restrict access to sugar-free fluids
Increase in the need to go to the toilet – please allow access to toilets
No urgent action is required to treat this unless the child is unwell.
If these symptoms are ignored the child may become flushed, drowsy,
complaining of stomach pain and may vomit. If this is the case contact
the parents or if appropriate the Diabetes Nurse Specialists.
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he same time every day.
Teenagers in secondary school
Basal–bolus regime
The choice of regime depends on the child preference and other factors such as
needle phobia but the preference is to start on a basal-bolus regime. More dietetic
input is required for this regime.
Long acting insulin analogue - 50% of total daily dose before evening meal or in the
evening.
Fast acting insulin analogue - 50% of total daily dose divided between 3 main meals
as below:
30% before breakfast
30% before lunch
40% before evening meal
Insulin: In this regime children take an injection of long acting insulin analogue
Glargine (Lantus®) or Detemir (Levemir®) once a day (in some cases twice daily).
This injection is usually given in the evening at the same time as their evening meal
insulin but in a different site. The long acting insulin should be given at the same
time every day to ensure a steady background insulin supply. Fast acting insulin
(Novorapid® or Humalog®) is given with meals (and snacks containing more than 10
g of CHO) based on how much carbohydrate they eat and the current blood sugar
result. There is no need to wait before eating once the injection has been given.
Dose adjustment: Before breakfast blood sugar will guide adjustment of the long
acting background insulin. It is important to get the background insulin dose right
before starting to adjust the bolus doses. Adjusting bolus insulin will depend on the
calculated insulin/CHO ratio for the patient. If the correct dose has been given the 2
hour post meal blood sugar will be in the normal range. If the pre meal blood sugar
is above 12 mmol/l an increased dose of insulin to include a correction dose can be
given.
Blood glucose testing: First thing in the morning and before meals.
Meals: There is no need to stick to a strict meal routine with this insulin regime.
Insulin should be given immediately prior to eating. Snacks are not compulsory and
should be taken according to natural hunger and predicted activity. Bed time snacks
are recommended if blood sugar is less than 8 mmol/l before bed.
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diabetes in young persons in elgin
CHO/ insulin ratios: Most children with established diabetes will be injecting 1 U of
insulin per 10g of CHO eaten. This can vary between children and they should let
you know which ratio they are currently using. An insulin injection is required for
meals as well as snacks including more than 10 g CHO.
Dose adjustment for blood sugar result: If the BG is high before a meal extra insulin
can be given to correct this. Aim to correct down to 10 mmol/l. Several formulas can
be used such as the Insulin Sensitivity Factor where 100 divided by total daily dose
equals number of mmol/l of glucose that will be reduced by 1 U of insulin.
Three times daily insulin regime
Premix insulin 30 - 2/3 of total daily dose before breakfast
Remaining insulin is further divided into 1/3 and 2/3, i.e.:
Fast acting soluble insulin - 1/9 of total daily dose before evening meal
Long acting isophane insulin – 2/9 of total daily dose before bed
Dose adjustment: Insulin is adjusted by reverse testing as per twice daily regime,
apart from the rapid acting insulin given with the evening meal which can be altered
according to food intake and current blood sugar result. Adjustment to insulin at
evening meal can also be made to take into account evening activities.
Blood glucose testing: Blood sugar should be tested before every insulin injection.
Meals: As per twice daily regime with some flexibility at the evening meal.
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