Hyperglycemia
Name some common symptoms of hyperglycemia that would signify the need to check ketones
Stomach ache, nausea, vomiting
Your student has PE at 1:00 pm. At what time should you place them in exercise/activity mode? For what time frame should it be in that mode?
30-60 minutes before and up to 1 hour after activity
At what threshold would you need new physician orders for treating hypoglycemia?
A BG over 80
Your UAP pulls the last back up pen out of the fridge to use. She puts the expiration date on the cap. It's now 1 day past expiration and the parent has not brought a new one. What should the UAP do?
Call their nurse
How often does each UAP need to take Diabetes Overview?
Every 3 years
What is happening in the body that causes students with type 1 diabetes to begin forming ketones
The lack of insulin in the body.
How often can you give a BG correction for a student who has a BG above target range using an insulin pump?
As often as the bolus calculator suggests a correction.
How many grams of carbs are needed to treat a low for students who are on an AID system?
5-10
Why do we strongly suggest that students on a pump have a back up pen (or vial) in the health room
How often should a back up that is delegated for diabetes perform a diabetes intervention in order to maintain their delegation competency.
At least a couple times a month
What direction would you give to a UAP when you discover that they are "walking" or "exercising" students with a BG above target range
Stop it! Activity does typically lower BG, but we need to follow the plan and not be missing class. Also, if the students begins to spill ketones, activity can actually increase BG.
What is the difference between a non-AID pump and a pump that is AID?
AID automatically adjust insulin based on the CGM data through a hybrid, closed-loop system. A traditional pump works off of preset basal and bolus settings
1. Low alarm during lunch
2. Low alarm after utilizing the catch-it-clause
3. Anytime symptoms don't match the CGM value
4. CGM still reads low 15 minutes after treatment
Treats in a classroom are happening 1 hour after lunch. A student with a pen shows up to the health room will a full plate of goodies and wanting to eat them. How would you direct the UAP in this situation?
Consult with the parent and RN for permission. You can always cover carbs.
You have a student who is frequently coming to the health room for diabetes intervention. What might you suggest to keep the student in the classroom?
1. Remote alarm notification monitoring
2. Consultation with teacher
3. Consultation with parent
List 2 scenarios in which you would suggest to your UAPs to check ketones
1. Anytime the BG is 300 or greater for 2 or more hours
2. Anytime the student is symptomatic (regardless of BG)
A student on an AID pump is low before lunch. They are now recovered at 105. What are the next steps for the UAP?
Once in range, students with an AID system can go ahead and bolus for lunch carbs and proceed to lunch
Your student is low at the pre-dismissal check. The bus is leaving shortly. What are the next steps for the UAP?
The student must be in range before getting on the bus. They may ask to hold the bus for a short time. If not, the student must be picked up. Ensure that pre-dismissal checks are 20-30 minutes prior to dismissal to provide time for treatment.
The student comes to the health room with a BG or 275 at 9:30 am and asks to do a correction via pen. What direction should the RN give the UAP?
RN should speak with parent to determine what the morning insulin regimen before school looked like
A parent calls your UAP and requests that all diabetes care be done in the classroom. How do you support/respond to this request?
Whenever we can possibly support in the classroom we want to do that. Reality of resources do not always allow for this.
A student on a pump comes to the health room with a BG of 285 at 9 am. The UAP gave a correction promted by the pump. By lunch time, the CGM read HIGH. What are the next steps for the UAP.
Do a finger stick, call RN, check ketones, prompt correction, give water
What is TIR and what are the parameters?
Percentage of Time In Range between 70-180. Ideal TIR is > or =70%, which is equivalent to an A1C of 7
A student comes down to the health room before lunch with a CGM reading of 54. After treatment, the BG is 68 on a finger stick. What are the next steps for the UAP?
Treat the student again for a low BG per the ISHP
The student comes in at 10am with a BG of 325. After consulting with RN and parent, it was decided to give a correction. Now it is 12:15 pm for pre-lunch dose. How would you direct the UAP to handle lunch dosing.
Because it has not been 3 hours, a BG correction cannot be given, but carbs should be covered at this time
A student with a pump is 405 and the parent asks the UAP to give a manual bolus of 1.5 units. How do you advise your UAP to proceed?
We do not do parent-directed care. If the student is mature enough, the parent could direct the student to do that manual bolus themselves.