LIBERTY SCHOOL DISTRICT
DIABETIC LOW BLOOD SUGAR PLAN
***NORMAL BLOOD SUGAR RANGE: ___ TO ____
(Low blood sugar is a life-threatening emergency)
Student Name:
Grade:
Teacher:
***NORMAL BLOOD SUGAR RANGE: ______ TO _______
Emergency Medications are stored in the ____________ Medication Cupboard.
Glucagon expires: _______________________
Medical Problem: Low blood sugar may be caused by too much insulin, missed or delayed snacks or meals, Too much or
unscheduled exercise. Has the potential to be life-threatening.
IF YOU SEE THIS:
DO THIS:
***________’s normal symptoms are in bold type***
IF ___________ IS SHOWING SIGNS OF LOW
BLOOD SUGAR, AN ADULT SHOULD ACCOMPANY
___ TO THE OFFICE IMMEDIATELY. OR CALL THE
OFFICE FOR ADULT HELP. NEVER SEND
____________ ANYWHERE ALONE!!!!
- Notify the school nurse immediately @ ext. 2211.
- __________ should check _____ blood sugar.
- If blood sugar < ________, give fast acting sugar:
4 oz. apple juice OR 2-4 glucose tablets.
- ______ should remain in office under adult supervision.
- Recheck blood sugar in 15 minutes.
- If blood sugar < ________, give fast acting sugar:
4 oz. apple juice OR 2-4 glucose tablets.
- Follow with 15-20 gm. Carbohydrate snack:
½ graham cracker sheet.
- Recheck blood sugar in 15 minutes.
- ______ may return to class when blood sugar > _____.
MILD:
Hunger.
Dizziness.
Shakiness.
Sweating.
Weakness.
Sleepiness.
Paleness.
Irritability.
Anxiety.
Inability to concentrate.
Personality/behavior changes.
MODERATE:
Headache.
Poor coordination.
Blurred vision.
Slurred speech.
Behavior changes.
Confusion.
Weakness.
SEVERE:
Loss of consciousness.
Seizure.
CALL 911 IMMEDIATELY!!!!
- School nurse or EMS may administer:
Glucagon _____ mg. IM/SC.
- DO NOT wait for parent to arrive before allowing
EMS to transport ___________ to the hospital.
Breathing and/or heartbeat stops.
CALL 911 IMMEDIATELY !!! Begin CPR/rescue
breathing and continue until relieved by EMS.
LIBERTY SCHOOL DISTRICT
DIABETIC HIGH BLOOD SUGAR PLAN
***NORMAL BLOOD SUGAR RANGE: ___ TO ____
(High blood sugar is not a medical emergency)
Student Name:
Grade:
Teacher:
***NORMAL BLOOD SUGAR RANGE: ______ TO _______
Emergency Medications are stored in the ____________ Medication Cupboard.
Insulin expires: _______________________
Medical Problem: Caused by too much food, too little insulin, too little physical activity, illness , infection and stress.
Onset can take several hours or days.
IF YOU SEE THIS:
***________________ normal symptoms are in bold type***
MILD:
Thirst.
Fatigue .
Hunger.
Stomach pains.
Sweet smelling breath.
Inability to concentrate.
Frequent urination.
Sleepiness.
Blurred vision.
Flushed skin.
Weight loss.
MODERATE:
Mild symptoms and
Nausea.
Stomach cramps
Dry mouth.
Vomiting.
DO THIS:
IF ___________ IS SHOWING SIGNS OF HIGH
BLOOD SUGAR, AN ADULT SHOULD ACCOMPANY
___ TO THE OFFICE IMMEDIATELY. OR CALL THE
OFFICE FOR ADULT HELP. NEVER SEND
____________ ANYHERE ALONE!!!!
- Have ___________ check blood sugar.
- Notify School Nurse at extension 2211.
- For blood sugar > _________________
1.) Have _________ drink _______ oz. of water.
2.) Have student do 15 minutes of walking in hall/gym.
- Check urine ketones for blood sugar > ___________
1.) Ketones: Trace to small - have student drink 16-24
oz. water over 2 hours. Recheck blood sugar and
ketones. If still positive – notify parent.
2.) Ketones: Moderate to large – Notify parent
immediately. If parent unavailable, notify MD.
- __________ should keep water bottle at their desk.
- __________ may need to use the bathroom frequently.
_________ is allowed to leave the classroom without
asking permission or notifying the teacher first.
SEVERE:
Mild or moderate symptoms and
Labored breathing.
Very weak.
Confused.
Unconscious.
CALL 911 IMMEDIATELY!!!
- Notify parent. Notify MD.
- DO NOT wait for parent to arrive before allowing
EMS to transport _____________ to the hospital.
Breathing and/or heartbeat stops.
CALL 911 IMMEDIATELY!!! Begin CPR/rescue
breathing and continue until relieved by EMS.