Diabetes. Emergency Checklists. From A Child in Your Care Has Diabetes. A Collection of Information. Copyright 2005 by Elisa Hendel, M.Ed.

Size: px
Start display at page:

Download "Diabetes. Emergency Checklists. From A Child in Your Care Has Diabetes. A Collection of Information. Copyright 2005 by Elisa Hendel, M.Ed."

Transcription

1 Diabetes Emergency Checklists From A Child in Your Care Has Diabetes. A Collection of Information. Copyright 2005 by Elisa Hendel, M.Ed.

2 Hyperglycemia High Blood Sugar * Hyperglycemia occurs when the blood sugar level becomes too high. High Blood Sugar = Blood Sugar (greater than) > 200 mg/dl. * High blood sugar can be caused by: not enough insulin, too much food, illness, inactivity or stress. * High blood sugar generally develops over a longer period of time. * Individuals may display an assortment of symptoms. Symptoms of High Blood Sugar may include: frequent urination increased thirst increased hunger lethargy blurry Vision stomachache nausea confusion Severe diabetic complications develop slowly, over several hours or days. Ketoacidosis = High blood glucose with a disturbance in the body s chemical balance. Life Threatening - unconsciousness - diabetic coma * At the onset of any symptoms, test blood sugar. * Treat high blood sugar immediately. * If symptoms are displayed and a glucose meter is not available. Treat the potential high! * If blood sugar is over 240 mg/dl, check for ketones. * Ketones are the breakdown products of fat metabolism. * A ketone test should be performed in the nurse s office. Urine is collected in a cup. Then, a special strip is dipped into the cup of urine. In approximately 15 seconds, the strip will change color. Use the packaging to read the results. * * * If the individual has HIGH blood sugar and ketones: contact the school nurse and family immediately. Drink water or sugar free drinks, 1-2 cups per hour. (no regular soda or juice) Do NOT exercise if blood sugar is > 250 mg/dl and ketones are present. Do NOT exercise if blood sugar is > 350 mg/dl with or without ketones. High blood sugar can be a warning that this individual is getting sick. Notify the school nurse of this condition. Notify a parent/a caretaker of this condition

3 Hypoglycemia Low Blood Sugar * Hypoglycemia is a very serious condition - it is often referred to as, Low Blood Sugar = usually Blood Sugar (less than) <70 mg/dl. * This occurs when there is too much insulin and not enough glucose in the bloodstream. It can happen suddenly...very quickly. * During hypoglycemia, an individual may display a range of symptoms. These reactions may differ slightly from person-to-person. Examples of Low Blood Sugar may include: dizziness shakiness pale coloring hunger nervousness nausea irrational behavior confusion personality change crying sweating headache blurry vision sluggishness poor coordination light headed If this individual is unconscious and cannot swallow, CALL 911 and immediately contact the nurse. A GLUCAGON Emergency Kit, must be used immediately! * At the onset of any symptoms, test blood sugar. * Treat low blood sugar immediately. If the symptoms are displayed and a meter is not available - TREAT THE POTENTIAL LOW!! * If the individual experiences a LOW blood sugar, get them a snack. Wait approximately 15 minutes and then retest blood sugar (BS). If the result is still considered low, add another 15 grams of carbohydrate. Call the family/doctor if this result continues. * If BS returns to normal and it is close to lunch, have the individual eat. However, if it is not near lunch time, a snack may be necessary. * A Glucagon Emergency Kit consists of a syringe, filled with liquid, that needs to be mixed with a powder. It is a natural hormone that sends a message to the liver or muscles to release stored sugar into the bloodstream. It is only used in the case of a Severe Hypoglycemic Emergency (seizure, unconsciousness, inability to swallow) and should be administered by a trained individual.

4 Important Phone Numbers Name: Address: School / Grade: Date: Name Number Home Phone Home Phone Cell Phone Cell Phone Work Number Work Number Doctor Diabetes Team Emergency Contact Insurance Company

5 General Diabetes Information Name: Address: School / Grade: Date: Type of Glucose Meter *Include Serial Number Blood Sugar Testing Information Can child perform own test? Yes No Adult Supervision needed? Yes No Insulin Information Can child inject insulin? Yes No Adult Supervision needed? Yes No Meals & Snacks Additional Information

6 Diabetes Supplies for Home & School It is the responsibility of the parent/caretaker of the child with diabetes to: ~ ~ ~ Supply the school with all diabetes supplies. Check all expiration dates for food and prescriptions. Check monthly to see if additional supplies are needed. Diabetes Supplies Diabetes Supplies Glucose Meter Glucagon Emergency Kit Control Solution for Meter Drinks Batteries for Meter Snacks Test Strips for Meter Glucose Tablets, Glucose Gel Lancing Device and Lancets Medical Orders (from Doctor) Insulin Health Care Plan Insulin Delivery Supplies School Plan (504 Plan) Ketone Strips Medical Identification

7 Testing Results & Instructions Name: Address: School / Grade: Date: RESULT (Blood Sugar Reading) SYMPTOMS COURSE OF ACTION What to do Target Blood Sugar Instructions: Hypoglycemia Low Blood Sugar Instructions: Hyperglycemia High Blood Sugar

8 Blood Sugar Log Name: Address: School / Grade: Date: Day Date Time Blood Sugar mg/dl Insulin Dosage

9 Glucagon Emergency Kit for Severe Hypoglycemia ~ A Glucagon Emergency Kit consists of a syringe filled with liquid, which must to be mixed with a powder. The kit comes with all necessary ingredients. ~ It is only used in the case of a Severe Hypoglycemic Emergency. Signs may include: disorientation, unconsciousness, seizures and an inability to swallow. ~ Anyone can be trained to administer this emergency shot. Detailed instructions are inside each kit. ~ Glucagon does NOT contain glucose or sugar. It is a natural hormone that sends a message to the liver or muscles to release stored sugar into the bloodstream. ~ If sugar storage is very low, one shot of Glucagon may not work-another shot may be needed. ~ Contact emergency medical services REQUEST A PARAMEDIC! Step-by-Step Glucagon Instructions 1. Inject the entire liquid contents of the syringe, into the small bottle. (Liquid into powder). Swirl contents in the bottle until mixture is fully dissolved. 2. Use the same syringe, hold bottle upside down. Put the syringe into the bottle and withdraw all liquid. 3. Turn the individual on their side as he/she may vomit. 4. Inject the Glucagon syringe into the arm, leg or buttocks. 5. If the individuals' condition does not improve, a 2nd shot may be necessary. 6. Once the individual is feeling better, a snack with carbohydrates and protein is suggested. 7. **For children 50 pounds and under ask your doctor for specific instructions.

10 Glucagon Emergency Kit Permission Form Name: Address: Phone: Date: To Whom it May Concern: Glucagon is a hormone made in the pancreas, like insulin. It has the opposite effect of insulin - it RAISES the blood sugar level. IT IS RARELY NEEDED, but it must be available. If a VERY LOW BLOOD SUGAR occurs and our child loses consciousness and cannot swallow, the Glucagon Emergency Kit must be used. *If necessary, call 911 for back-up. The school nurse has been trained in the administration of Glucagon. In addition to the school nurse, the following staff members have been instructed in Glucagon delivery and have our permission to administer it: Name Signature Date /Guardian Signature Phone Number Date Physician Signature Phone Number Date

Children With Diabetes. With Glucagon Training For School Staff

Children With Diabetes. With Glucagon Training For School Staff Children With Diabetes With Glucagon Training For School Staff Goals for today Understand what diabetes is. Recognize a hypoglycemic reaction. Understand the intended purpose and the side effects of a

More information

Hypoglycemia: Low Blood Sugar

Hypoglycemia: Low Blood Sugar Hypoglycemia: Low Blood Sugar What is hypoglycemia? Hypoglycemia (or low blood sugar) occurs when the blood glucose falls below 70 mg/dl. Symptoms may also be noticed when there is a rapid decrease in

More information

Diabetes Insulin Pump Health Care Plan District Nurse Phone: 262-560-2104 District Nurse Fax: 262-560-2106

Diabetes Insulin Pump Health Care Plan District Nurse Phone: 262-560-2104 District Nurse Fax: 262-560-2106 EMPOW ERING A COMMUNITY OF LEARNERS AND LEADERS Diabetes Insulin Pump Health Care Plan District Nurse Phone: 262-560-2104 District Nurse Fax: 262-560-2106 Student DOB School Grade Doctor Phone School Year

More information

Management of Diabetes

Management of Diabetes Management of Diabetes Blood Glucose Monitoring MANAGEMENT OF DIABETES Once someone is told they have diabetes, they are usually asked to check their blood glucose at home with a home blood glucose meter

More information

Anchor Bay School District Diabetic Medical Care Plan. Student Name Date Grade Teacher

Anchor Bay School District Diabetic Medical Care Plan. Student Name Date Grade Teacher Rev: 4/2009 Anchor Bay School District Diabetic Medical Care Plan Place Child s Picture Here Student Name Date Grade Teacher Emergency Contact information (Please list in order to be called) #1 Parent

More information

BLOOD GLUCOSE MONITORING MEDICATION

BLOOD GLUCOSE MONITORING MEDICATION DIABETES CARE FOR SCHOOL MEDICAL MANAGEMENT PLAN Most Recent A1C and Date: BLOOD GLUCOSE MONITORING Meter Type: Testing Independently: yes no Testing times: Before meals Two hours after insulin dosing

More information

How to Prepare & Inject Glucagon For Treatment of Severe Hypoglycemia in Persons with Diabetes

How to Prepare & Inject Glucagon For Treatment of Severe Hypoglycemia in Persons with Diabetes How to Prepare & Inject Glucagon For Treatment of Severe Hypoglycemia in Persons with Diabetes Islets of Hope Publication TRE-1-2006 Become familiar with the information in this publication BEFORE an emergency!

More information

Diabetes Health Care Plan Insulin Dosing Guidelines District Nurse Phone: District Nurse Fax:

Diabetes Health Care Plan Insulin Dosing Guidelines District Nurse Phone: District Nurse Fax: Diabetes Health Care Plan Insulin Dosing Guidelines District Nurse Phone: 262-560-2104 District Nurse Fax: 262-560-2106 Date: School Year: School: Grade:,, DOB: was diagnosed with Diabetes Type 1 Type

More information

Blood Glucose Management

Blood Glucose Management Blood Glucose Management What Influences Blood Sugar Levels? There are three main things that influence your blood sugar: Nutrition Exercise Medication What Influences Blood Sugar Levels? NUTRITION 4 Meal

More information

Diabetes Medical Management Plan

Diabetes Medical Management Plan Diabetes Medical Management Plan 1 School District: School: School Year: Grade: Student Name: DOB: Provider Name: Phone #: Fax #: Blood Glucose Monitoring at School Blood Glucose Target Range: - mg/dl

More information

Diabetes Medical Management Plan

Diabetes Medical Management Plan 1 Diabetes Medical Management Plan School District: School: School Year: Grade: Student Name: DOB: Provider Name: Phone #: Fax #: Blood Glucose Monitoring at School Blood Glucose Target Range: - mg/dl

More information

Copyright 2008, Nationwide Children's Hospital

Copyright 2008, Nationwide Children's Hospital Diabetes: What Schools Should Know (School Health Plan) Diabetes is a disease in which the body is unable to utilize sugar effectively, resulting in high blood sugar levels. In order to maintain a normal

More information

Diabetes Management and Treatment Plan for School (For the insulin pump student)

Diabetes Management and Treatment Plan for School (For the insulin pump student) Lafayette School Corporation Health Services Diabetes Management and Treatment Plan for School (For the insulin pump student) Effective Dates: This plan should be complete by the student s personal health

More information

IN THE SCHOOL SETTING:

IN THE SCHOOL SETTING: MANAGING TYPE 1 DIABETES IN THE SCHOOL SETTING: A Guide for Non-Medical Personnel in Schools DIABETES CONTROL AND MANAGEMENT A student s diabetes treatment plan starts with: EATING consistently on a schedule

More information

DIABETES MANAGEMENT: INFORMATION FOR COACHES SHNIC

DIABETES MANAGEMENT: INFORMATION FOR COACHES SHNIC DIABETES MANAGEMENT: INFORMATION FOR COACHES SHNIC Objectives The participant will be able to state the definition of diabetes. The participant will be able to identify signs and symptoms of hypoglycemia.

More information

Diabetes Medical Management Plan

Diabetes Medical Management Plan Diabetes Medical Management Plan Student s Name: Grade: School: School Year: Diabetes Type 1: Diabetes Type 2: Date of Diagnosis: Blood Glucose Monitoring ~ Target blood glucose range: to mg/dl Usual times

More information

Student Name: Date of Birth:

Student Name: Date of Birth: Place Photo Here ITASCA DISTRICT 10 DIABETES CARE PLAN Student Name: Date of Birth: Date of Conference: School Nurse: Health Data: has diabetes. This is a condition in which the pancreas is unable to make

More information

Diab.etes Me.dic.al-Ma-nage-me-n-t -P-la-n -.

Diab.etes Me.dic.al-Ma-nage-me-n-t -P-la-n -. Date of Plan: Diab.etes Me.dic.al-Ma-nage-me-n-t -P-la-n -. Effective Dates: WJ Student's Name: Date of Birth:,-..,,;... Date of Diabetes Diagnosis: Grade: Homeroom Teacher: Physical Condition: 0 Diabetes

More information

GLUCAGON FOR INJECTION (rdna ORIGIN)

GLUCAGON FOR INJECTION (rdna ORIGIN) Source: http://www.lillyglucagon.com/how-to-use accessed March 6, 2015 1 INFORMATION FOR THE USER PA 2286 AMP GLUCAGON FOR INJECTION (rdna ORIGIN) BECOME FAMILIAR WITH THE FOLLOWING INSTRUCTIONS BEFORE

More information

School Year 20 / 20. Diabetes Health Care Plan for Southgate Schools

School Year 20 / 20. Diabetes Health Care Plan for Southgate Schools School Year 20 / 20 Diabetes Health Care Plan for Southgate Schools Diabetes Medical Management Plan, Initialized Healthcare Plan and Physician Orders Part A: Contact Information must be completed by the

More information

FHUSD Diabetic Management Plan

FHUSD Diabetic Management Plan This plan should be completed by the student s personnel Physician or Licensed Healthcare Provider and parent/guardian. It should be reviewed with relevant school staff and copies should be kept in a place

More information

Type 1 Diabetes. Pennington Nutrition Series. Overview. About Insulin

Type 1 Diabetes. Pennington Nutrition Series. Overview. About Insulin Pennington Nutrition Series Healthier lives through education in nutrition and preventive medicine Pub No. 32 Type 1 Diabetes Overview Type 1 Diabetes (DM) is usually diagnosed in children and young adults.

More information

Health Care Provider Signature Parent Signature

Health Care Provider Signature Parent Signature Diabetes Action Plan Childs picture here. Name of Child DOB Date TO BE COMPLETED BY HEALTH CARE PROVIDER Blood Glucose Monitoring: Target range for blood glucose: mg/dl to mg/dl Times to check blood glucose:

More information

DIABETES MEDICAL MANAGEMENT PLAN (DMMP) For Student Requiring Insulin Therapy

DIABETES MEDICAL MANAGEMENT PLAN (DMMP) For Student Requiring Insulin Therapy DIABETES MEDICAL MANAGEMENT PLAN (DMMP) For Student Requiring Insulin Therapy This plan should be completed by the student s parent(s)/guardian(s) and the diabetes health care team. It should be reviewed

More information

See, Think, and Act! Diabetes

See, Think, and Act! Diabetes See, Think, and Act! Diabetes California After School Resource Center (CASRC) Administered for the California Department of Education (C.D.E.) Hello. My name is Joan Edelstein. I am a health trainer for

More information

LOW BLOOD Glucose with TYPE 1 DIABETES

LOW BLOOD Glucose with TYPE 1 DIABETES LOW BLOOD Glucose with TYPE 1 DIABETES Hypoglycemia is the medical term for low blood glucose or low blood sugar. It occurs when blood glucose (sugar) drops below the normal range (i.e below 4 mmol/l).

More information

Green Brook Township School District DIABETES- Insulin Pump IHP/IEHP

Green Brook Township School District DIABETES- Insulin Pump IHP/IEHP Green Brook Township School District DIABETES- Insulin Pump IHP/IEHP 1. Personal Information: I. STUDENT INFORMATION NAME: Grade HR.- Teacher: Address Home Phone #: Birth date Bus: # N/A Gender Male Female

More information

OFFICE OF CATHOLIC SCHOOLS DIOCESE OF ARLINGTON DIABETES MEDICAL MANAGEMENT PLAN Page 1 of 5 TO BE COMPLETED BY PARENT OR GUARDIAN

OFFICE OF CATHOLIC SCHOOLS DIOCESE OF ARLINGTON DIABETES MEDICAL MANAGEMENT PLAN Page 1 of 5 TO BE COMPLETED BY PARENT OR GUARDIAN PART I OFFICE OF CATHOLIC SCHOOLS DIOCESE OF ARLINGTON DIABETES MEDICAL MANAGEMENT PLAN Page 1 of 5 TO BE COMPLETED BY PARENT OR GUARDIAN Student School Date of Birth Date of Diagnosis Grade/ Teacher Physical

More information

Diabetes Hypoglycemia/Hyperglycemia Reaction

Diabetes Hypoglycemia/Hyperglycemia Reaction Diabetes Hypoglycemia/Hyperglycemia Reaction Hypoglycemic Reaction (Insulin Shock) A. Hypoglycemic reactions (insulin reactions) should be treated according to current nursing and medical recommendations.

More information

Riley Hospital for Children General Diabetes Medical Management Information- Injections

Riley Hospital for Children General Diabetes Medical Management Information- Injections Riley Hospital for Children General Diabetes Medical Management Information- Injections 1. HEALTH CARE SUPERVISION All school support staff, including: secretaries, cafeteria staff, custodians and bus

More information

Managing Diabetes in the School Setting. Alabama State Department of Education Alabama Board of Nursing

Managing Diabetes in the School Setting. Alabama State Department of Education Alabama Board of Nursing Managing Diabetes in the School Setting Alabama State Department of Education Alabama Board of Nursing Diabetes Mellitus: Type I Diabetes Previously called Insulin-dependent or Juvenile Onset Diabetes

More information

AP Support for Students with Type 1 Diabetes (T1D)

AP Support for Students with Type 1 Diabetes (T1D) AP 323 - Support for Students with Type 1 Diabetes (T1D) Background The purpose of this procedure is to outline staff responsibilities for supporting students with Type 1 Diabetes (T1D). T1D is a disease

More information

DIABETIC EDUCATION MODULE ONE GENERAL OVERVIEW OF TREATMENT AND SAFETY

DIABETIC EDUCATION MODULE ONE GENERAL OVERVIEW OF TREATMENT AND SAFETY DIABETIC EDUCATION MODULE ONE GENERAL OVERVIEW OF TREATMENT AND SAFETY First Edition September 17, 1997 Kevin King R.N., B.S., C.C.R.N. Gregg Kunder R.N., B.S.N., C.C.T.C. 77-120 CHS UCLA Medical Center

More information

SAMPLE SECTION 504 PLAN

SAMPLE SECTION 504 PLAN DREDF Disability Rights Education and Defense Fund, Inc. SAMPLE SECTION 504 PLAN The attached sample Section 504 Plan was developed by the American Diabetes Association (ADA) and the Disability Rights

More information

Diabetes Health Care Plan

Diabetes Health Care Plan The Public Schools of Brookline School Health Services of Plan: Diabetes Health Care Plan To be completed by the student s health care team and parents/guardian. Plan will be kept with the school nurse

More information

INSULIN-DEPENDENT DIABETES HEALTH CARE PLAN: II

INSULIN-DEPENDENT DIABETES HEALTH CARE PLAN: II INSULIN-DEPENDENT DIABETES HEALTH CARE PLAN: II DATE: SCHOOL: GRADE: STUDENT: BIRTHDATE: HOME ADDRESS: PARENT/GUARDIAN: PARENT S PHONE: Home: Mom s work: Dad s work: EMERGENCY CONTACT (NAME, NUMBER and

More information

Hypoglycemia and Diabetes

Hypoglycemia and Diabetes My Doctor Says I Should Avoid Low Blood Glucose Reactions... How Can I Prevent Them? BD Getting Started Hypoglycemia and Diabetes What You Should Know About Low Blood Glucose Reactions If you are taking

More information

Basics of Blood Sugars

Basics of Blood Sugars PATIENT EDUCATION patienteducation.osumc.edu What is a blood glucose level? A blood glucose level is the amount of glucose (sugar) in your blood. When you take a steroid medicine, your blood sugar can

More information

GLUCAGON ADMINISTRATION STUDENTS WITH TYPE 1 DIABETES AUGUST 2016

GLUCAGON ADMINISTRATION STUDENTS WITH TYPE 1 DIABETES AUGUST 2016 GLUCAGON ADMINISTRATION STUDENTS WITH TYPE 1 DIABETES AUGUST 2016 PURPOSE To train designated school staff how to recognize low blood sugar and administer glucagon for treatment of severe low blood sugar.

More information

TO BE COMPLETED BY LICENSED HEALTH CARE PROFESSIONAL

TO BE COMPLETED BY LICENSED HEALTH CARE PROFESSIONAL PART I OFFICE OF CATHOLIC SCHOOLS DIOCESE OF ARLINGTON DIABETES MEDICAL MANAGEMENT PLAN Page 1 of 5 TO BE COMPLETED BY PARENT OR GUARDIAN Student School Date of Birth Date of Diagnosis Grade/ Teacher Physical

More information

Young Marines Diabetes Care Plan

Young Marines Diabetes Care Plan PO Box 70735, SW Station Washington, DC 20024-0735 800-717-0060 office / 202-889-0502 fax Young Marines Diabetes Care Plan Child s Name: Date of Birth: Age: Unit: Event: (Drill, Encampment, SPACES, NDSP,

More information

SCHOOL DISTRICT #22 VERNON DIABETES POLICY

SCHOOL DISTRICT #22 VERNON DIABETES POLICY SCHOOL DISTRICT #22 VERNON DIABETES POLICY A student with diabetes does not automatically qualify for additional support. The student may qualify as a temporary D category (chronic health) after diagnosis

More information

Diabetes Management and Treatment Plan

Diabetes Management and Treatment Plan Date of Plan: Diabetes Management and Treatment Plan Effective Dates: This plan should be completed by the student s personal health team and parents/guardian. It should be reviewed with relevant school

More information

DIABETES MEDICAL MANAGEMENT PLAN (DMMP) For Student Requiring Insulin Therapy

DIABETES MEDICAL MANAGEMENT PLAN (DMMP) For Student Requiring Insulin Therapy This plan should be completed by the student s parent(s)/guardian(s) and the diabetes health care team. It should be reviewed with relevant school staff and copies should be kept in a place that can be

More information

Hypoglycemia. Low Blood Sugar Reaction

Hypoglycemia. Low Blood Sugar Reaction Hypoglycemia Low Blood Sugar Reaction Objectives At the conclusion of this program, you will be able to: 1. Recognize the signs and symptoms of hypoglycemia 2. Treat hypoglycemia 3. Know what to do to

More information

Type 2 Diabetes Type 2 Diabetes

Type 2 Diabetes Type 2 Diabetes Pennington Nutrition Series Healthier lives through education in nutrition and preventive medicine Pub No. 33 Type 2 is the most common form of diabetes. In this form, the body does not produce enough

More information

THE MOLLY CENTER FOR CHILDREN WITH DIABETES AND ENDOCRINE DISORDERS DIABETES-HEALTH CARE PLAN

THE MOLLY CENTER FOR CHILDREN WITH DIABETES AND ENDOCRINE DISORDERS DIABETES-HEALTH CARE PLAN THE MOLLY CENTER FOR CHILDREN WITH DIABETES AND ENDOCRINE DISORDERS DIABETES-HEALTH CARE PLAN (To be completed by parent and school nurse) DATE: SCHOOL: GRADE: STUDENT: BIRTHDATE: HOME ADDRESS: PARENT/GUARDIAN:

More information

WHAT I NEED TO KNOW ABOUT MY BLOOD SUGAR

WHAT I NEED TO KNOW ABOUT MY BLOOD SUGAR WHAT I NEED TO KNOW ABOUT MY BLOOD SUGAR BLOOD WHAT I NEED SUGAR TO MANAGEMENT KNOW ABOUT GUIDE MY BLOOD SUGAR When you have type 2 diabetes, your body has a problem using the food you eat for energy.

More information

Name Date. Doctor. Usual times to test glucose at school Extra tests (check those that apply) before exercise after exercise other (explain)

Name Date. Doctor. Usual times to test glucose at school Extra tests (check those that apply) before exercise after exercise other (explain) Appendix A SAMPLE IHP Name Date Phone numbers Blood glucose Hypoglycemia Hyperglycemia Insulin Parent/guardian#1 Work Home Parent/guardian#2 Work Home Other emergency contact Doctor Usual times to test

More information

Telephone: Home Work Cell E-mail Address Father/Guardian: Address:

Telephone: Home Work Cell E-mail Address Father/Guardian: Address: SAMPLE Diabetes Medical Management Plan/Individualized Healthcare Plan Part A: Contact Information must be completed by the parent/guardian. Part B: Diabetes Medical Management Plan (DMMP) must be completed

More information

Diabetes Medical Management Plan (DMMP)

Diabetes Medical Management Plan (DMMP) Diabetes Medical Management Plan (DMMP) This plan should be completed by the student s personal diabetes health care team, including the parents/guardian. It should be reviewed with relevant school staff

More information

Objectives. Managing Diabetes Emergencies in the School Setting. The Law. The Law. Diabetes Plan of Care. Plans of care 10/11/2010

Objectives. Managing Diabetes Emergencies in the School Setting. The Law. The Law. Diabetes Plan of Care. Plans of care 10/11/2010 Managing Diabetes Emergencies in the School Setting Cherrie Cowan MS Diabetes and Family Nurse Practitioner Objectives Review of Diabetes care tasks and what key personnel need to know. Review of recognition

More information

EPCHS Health Center 1401 E Washington St East Peoria IL Phone: Fax:

EPCHS Health Center 1401 E Washington St East Peoria IL Phone: Fax: EPCHS Health Center 1401 E Washington St East Peoria IL 61611 Phone: 309-694-8313 Fax: 309-694-8322 Diabetes Medical Management Plan (DMMP) Date of Plan: This plan is valid for the current school year:

More information

SAMPLE SECTION 504 PLAN

SAMPLE SECTION 504 PLAN . SAMPLE SECTION 504 PLAN The attached sample Section 504 Plan was developed by the American Diabetes Association (ADA) and the Disability Rights Education and Defense Fund, Inc. (DREDF). For further information,

More information

X-Plain Hypoglycemia Reference Summary

X-Plain Hypoglycemia Reference Summary X-Plain Hypoglycemia Reference Summary Introduction Hypoglycemia is a condition that causes blood sugar level to drop dangerously low. It mostly shows up in diabetic patients who take insulin. When recognized

More information

ALVIN INDEPENDENT SCHOOL DISTRICT Diabetes Medical Management Plan

ALVIN INDEPENDENT SCHOOL DISTRICT Diabetes Medical Management Plan ALVIN INDEPENDENT SCHOOL DISTRICT Diabetes Medical Management Plan of Plan: School Year (must be current): This plan should be completed by the student s personal health care team and parents/guardian.

More information

Riley Hospital for Children General Diabetes Medical Management Information- Pump Therapy

Riley Hospital for Children General Diabetes Medical Management Information- Pump Therapy Riley Hospital for Children General Diabetes Medical Management Information- Pump Therapy 1. HEALTH CARE SUPERVISION All school support staff, including: secretaries, cafeteria staff, custodians and bus

More information

Dear Parent/Guardian and Physician of

Dear Parent/Guardian and Physician of DIABETIC MANAGEMENT PLAN Parent Consent and Physician Authorization POWAY UNIFIED SCHOOL DISTRICT HEALTH SERVICES 15250 Avenue of Science San Diego CA 92128 Dear Parent/Guardian and Physician of California

More information

2. What Should Advocates Know About Diabetes? O

2. What Should Advocates Know About Diabetes? O 2. What Should Advocates Know About Diabetes? O ften a school district s failure to properly address the needs of a student with diabetes is due not to bad faith, but to ignorance or a lack of accurate

More information

Vanderbilt Sports Medicine Diabetes Care Plan

Vanderbilt Sports Medicine Diabetes Care Plan Pre Participation Examination and Clearance Vanderbilt Sports Medicine Diabetes Care Plan History Questionnaire must include: Do you have frequent urination? Do you have excessive thirst? Do you have frequent

More information

Diabetes Medical Management Plan (DMMP)

Diabetes Medical Management Plan (DMMP) Diabetes Medical Management Plan (DMMP) This plan should be completed by the student s personal diabetes health care team, including the parents/guardian. It should be reviewed with relevant school staff

More information

Tips to Help Teachers Keep Kids with Diabetes Safe at School

Tips to Help Teachers Keep Kids with Diabetes Safe at School Tips to Help Teachers Keep Kids with Diabetes Safe at School Presenter School Name Date About Diabetes Nearly 21 million adults and children in the U.S. have diabetes. This includes children at

More information

Section 504 Plan (pg 1 of 8)

Section 504 Plan (pg 1 of 8) Section 504 Plan (pg 1 of 8) of Birth School Today s Section 504 Plan for: Disability: Diabetes School Year: Grade: Homeroom Teacher: Bus Number: Background Objectives The student has type diabetes. Diabetes

More information

Diabetes Medical Management Plan for: Grade:

Diabetes Medical Management Plan for: Grade: SCHOOL YEAR: KINGSWAY REGIONAL SCHOOL DISTRICT SCHOOL HEALTH SERVICES 201 Kings Highway Woolwich Township, NJ 08085 HIGH SCHOOL: Phone (856) 467-3300 Fax (856) 467-4136 MIDDLE SCHOOL: Phone (856) 467-3300

More information

SAMPLE SECTION 504 PLAN

SAMPLE SECTION 504 PLAN SAMPLE SECTION 504 PLAN The attached sample Section 504 Plan was developed by the American Diabetes Association (ADA) and the Disability Rights Education and Defense Fund, Inc. (DREDF). 0 MODEL 504 PLAN

More information

YMCA of Metro Chicago Diabetes Medical Management Plan (DMMP)

YMCA of Metro Chicago Diabetes Medical Management Plan (DMMP) YMCA of Metro Chicago Diabetes Medical Management Plan (DMMP) of Plan / / Plan Effective s: / / through / / MEMBER INFORMATION PLEASE PRINT First Last of Birth / / of diabetes diagnosis Type 1 Type 2 Other

More information

Glucagon Training Standards for School Personnel: Providing Emergency Medical Assistance to Pupils with Diabetes

Glucagon Training Standards for School Personnel: Providing Emergency Medical Assistance to Pupils with Diabetes Glucagon Training Standards for School Personnel: Providing Emergency Medical Assistance to Pupils with Diabetes Performance Standards for the Training and Supervision of School Personnel in Providing

More information

Feeling Better, Living Healthier With Diabetes

Feeling Better, Living Healthier With Diabetes Feeling Better, Living Healthier With Diabetes A guide for self management 761 S. Nelson Ave. Wilmington, Ohio 45177 (937) 382-9307 www.cmhregional.com What is Diabetes? Those who have diabetes are often

More information

High Blood Sugar, Low Blood Sugar. Let s Check our Blood Sugar

High Blood Sugar, Low Blood Sugar. Let s Check our Blood Sugar High Blood Sugar, Low Blood Sugar Testing your blood sugar Check with your provider to see if and when he/she wants you to check your blood sugar. Keep a record of your blood sugar numbers, the date and

More information

Form Diabetes Care Plan

Form Diabetes Care Plan Form 504.1.5 Diabetes Care Plan Diabetes Care Plan Diabetes Care Plan For: School: Effective Dates: Date of Birth: Grade: Homeroom Teacher: Place photo of student here. Contact Information Parents/Guardians

More information

Diabetes Education Information for Teachers and School staff

Diabetes Education Information for Teachers and School staff Diabetes Education Information for Teachers and School staff The information below is intended to educate school staff on the basics of diabetes care. If you have a student in your classroom or you will

More information

Section 6: Diabetes Emergencies

Section 6: Diabetes Emergencies Section 6: Diabetes Emergencies SECTION OVERVIEW General Overview Low Blood Glucose (Hypoglycemia) Glucagon High Blood Glucose (Hyperglycemia) Diabetic Ketoacidosis Monitoring Ketones Emergency Medical

More information

Blood glucose monitoring. The act of checking the amount of glucose in the blood. Also called self-monitoring of blood glucose.

Blood glucose monitoring. The act of checking the amount of glucose in the blood. Also called self-monitoring of blood glucose. 1 Glossary Adapted from Helping the Student with Diabetes Succeed A Guide for School Personnel. A Americans with Disabilities Act. A federal law enacted in 1990 to protect people with disabilities from

More information

Virginia School Diabetes Medical Management Plan (DMMP) Part 1 Contact Information and Medical History

Virginia School Diabetes Medical Management Plan (DMMP) Part 1 Contact Information and Medical History Virginia School Diabetes Medical Management Plan (DMMP) Part 1 Contact Information and Medical History Virginia Diabetes Council - School Diabetes Care Practice and Protocol - Provides guidelines, recommended

More information

TYPE 2 DIABETES PROCEDURES AND FORMS ELEMENTARY SECONDARY SCHOOL ADMINISTRATOR

TYPE 2 DIABETES PROCEDURES AND FORMS ELEMENTARY SECONDARY SCHOOL ADMINISTRATOR TYPE 2 DIABETES PROCEDURES AND FORMS ELEMENTARY SECONDARY SCHOOL ADMINISTRATOR 2013 SCHOOL ADMINISTRATOR TYPE 2 DIABETES PROCEDURES and FORMS: Parent/guardian informs school administrator child/youth has

More information

Getting the Big Picture

Getting the Big Picture About Diabetes This health information is being provided for general educational purposes only. Your health care provider is the single best source of information regarding your health. Please consult

More information

Diabetes-Related High and Low Blood Sugar

Diabetes-Related High and Low Blood Sugar Diabetes-Related High and Low Blood Sugar Topic Overview When you have diabetes, you may have high blood sugar levels (hyperglycemia) or low blood sugar levels (hypoglycemia) from time to time. A cold,

More information

X-Plain Diabetes - Introduction Reference Summary

X-Plain Diabetes - Introduction Reference Summary X-Plain Diabetes - Introduction Reference Summary Introduction Diabetes is a disease that affects millions of Americans every year. Your doctor may have informed you that you have diabetes. Although there

More information

Guidelines for the Care Needed for Students with Diabetes

Guidelines for the Care Needed for Students with Diabetes Guidelines for the Care Needed for Students with Diabetes for the implementation of State Board of Education Rule 160-4-8-.18 Diabetes Medical Management Plans Version 1.0 Table of Contents (1) DEFINITIONS:...

More information

Doing your level best

Doing your level best New blood sugar target goals to consider Doing your level best One of your main goals in treating diabetes is to keep your blood sugar level as close to normal as possible. It takes some effort, but it

More information

Diabetes - Introduction

Diabetes - Introduction Diabetes - Introduction Introduction Diabetes is a disease that affects hundreds of millions of people worldwide. Your health care provider may have informed you that you have diabetes. Although there

More information

N HUMAN Novo Nordisk Patient Information for Novolin N

N HUMAN Novo Nordisk Patient Information for Novolin N N HUMAN Novo Nordisk Patient Information for Novolin N NOVOLIN N (NO-voe-lin) NPH, Human Insulin Isophane Suspension Injection (recombinant DNA origin) 100 units/ml Important: Know your insulin. Do not

More information

SCHOOL DISTRICT #43 (COQUITLAM) MEDICAL ALERT FORMS FORM(S) MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR

SCHOOL DISTRICT #43 (COQUITLAM) MEDICAL ALERT FORMS FORM(S) MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR SCHOOL DISTRICT #43 (COQUITLAM) MEDICAL ALERT FORMS FORM(S) MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR Please read instructions below carefully. Feel free to contact your school if you need any

More information

Training for Unlicensed Diabetes Care Assistants Pre-and Post-Test. Name: Date:

Training for Unlicensed Diabetes Care Assistants Pre-and Post-Test. Name: Date: Training for Unlicensed Diabetes Care Assistants Pre-and Post-Test Name: Date: To check your understanding about how to assist students with diabetes in school, the following questions are about imaginary

More information

EDISON TOWNSHIP PUBLIC SCHOOLS DIVISION OF HEALTH SERVICES. Diabetes Medical Management Plan

EDISON TOWNSHIP PUBLIC SCHOOLS DIVISION OF HEALTH SERVICES. Diabetes Medical Management Plan EDISON TOWNSHIP PUBLIC SCHOOLS DIVISION OF HEALTH SERVICES HS Form # 31 Diabetes Medical Management Plan Part A: Contact Information must be completed by the parent/guardian Part B: Authorization for Services

More information

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. Diabetes Definition Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Causes Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused

More information

N E B R A S K A JAIL BULLETIN NUMBER 102 OCTOBER 1993

N E B R A S K A JAIL BULLETIN NUMBER 102 OCTOBER 1993 N E B R A S K A JAIL BULLETIN NUMBER 102 OCTOBER 1993 The Jail Bulletin is a monthly feature of the Crime Commission Update. The Bulletin may be used as a supplement to your jail in-service training program

More information

Hypoglycaemia. Hypoglycaemia can be caused by:

Hypoglycaemia. Hypoglycaemia can be caused by: Hypoglycaemia What is hypoglycaemia? Hypoglycaemia ( Hypo ) means a low level of glucose in the blood. For people with type 1 diabetes, this is a blood glucose value of less than 4.0 mmol/l. Mild to moderate

More information

Steroid Induced Diabetes

Steroid Induced Diabetes What is high blood sugar (hyperglycemia)? Hyperglycemia is a high level of sugar in the blood. Blood sugar is also called glucose. Some people are unable to process the sugar that is found in food and

More information

Individualized Health Care Plan for Diabetes

Individualized Health Care Plan for Diabetes Individualized Health Care Plan for Diabetes DOB: School: Physician: Daily Management Information for Diabetes Care: 1. Documentation of Diabetes Care: Computerized flow sheet Paper flow sheet Self-care

More information

X-Plain Diabetes - Introduction Reference Summary

X-Plain Diabetes - Introduction Reference Summary X-Plain Diabetes - Introduction Reference Summary Introduction Diabetes is a disease that affects millions of Americans every year. Your doctor may have informed you that you have diabetes. Although there

More information

Gestational Diabetes

Gestational Diabetes Gestational Diabetes Gestational diabetes is a condition characterized by high blood glucose (sugar) levels that are discovered during pregnancy. It is defined as carbohydrate intolerance. About 3 percent

More information

DIABETES CARE TASKS AT SCHOOL: What Key Personnel Need to Know

DIABETES CARE TASKS AT SCHOOL: What Key Personnel Need to Know DIABETES CARE TASKS AT SCHOOL: What Key Personnel Need to Know HYPERGLYCEMIA Goal: Optimal Student Health and Learning Managing hyperglycemia is a vital piece of a comprehensive plan. 2 Learning Objectives

More information

Diabetes Individual Healthcare Plan

Diabetes Individual Healthcare Plan Henry P. Becton Regional High School/Health Department Diabetes Individual Healthcare Plan Date of Plan: Effective for the school year Student s Name: Date of Birth Grade: Date of Diabetes Diagnosis: Type

More information

Equipment and Supplies Checklist for Parents Student: DOB: School: Grade: Equipment and Supplies to be Provided by Parent. Parent Signature Date

Equipment and Supplies Checklist for Parents Student: DOB: School: Grade: Equipment and Supplies to be Provided by Parent. Parent Signature Date Equipment and Supplies Checklist for Parents Student: DOB: School: Grade: Equipment and Supplies to be Provided by Parent Parent Signature Date Daily Snacks (for AM/PM snack times): Specify: Extra Snacks

More information

Causes, incidence, and risk factors

Causes, incidence, and risk factors Causes, incidence, and risk factors Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes,

More information

Glucagon Education for School Nurses in Tennessee. by Mary Kornguth PhD, RN, NCSN

Glucagon Education for School Nurses in Tennessee. by Mary Kornguth PhD, RN, NCSN Glucagon Education for School Nurses in Tennessee by Mary Kornguth PhD, RN, NCSN Objectives: At the end of this module the school nurse will be able to: 1. State what glucagon is and describe its action

More information

Provincial Standards: Supporting Students with Type 1 Diabetes in the School Setting

Provincial Standards: Supporting Students with Type 1 Diabetes in the School Setting Provincial Standards: Supporting Students with Type 1 Diabetes in the School Setting March 2015 Contents Purpose of this Document... 2 Basic Facts about Type 1 Diabetes... 3 Supportive Environment... 3

More information