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Considerations:
Low blood sugar in children with diabetes can have varied symptoms. These can include but are not limited to:
- nervousness,
- shakiness,
- weakness,
- extreme hunger,
- slight nausea,
- dizziness,
- headache,
- blurred vision,
- fast heartbeat and/or
- feeling tired.
Supplies:
- Glucagon kit
- Gloves
- Medication order
Procedure:
- Identify that symptoms of a severe low blood sugar reaction are present and that based on the child’s diabetes emergency plan, medication needs to be given
- Call for assistance
- Ask that another school staff person call 911 or emergency medical services
- If able, move the student to a lying position
- Explain the procedure to the child at his/her level of understanding
- Check the medication and the order to be sure it is:
- For the right child
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Be sure to check the medication to ensure that it has not expired
- Wash your hands, if possible
- Assemble supplies and place on a clean surface
- Quickly review the five rights once again while checking the glucagon to be sure it is:
- For the right child
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Be sure to check the medication to ensure that it is not expired
- Put on gloves
- Remove the glucagon vial and syringe containing the liquid or diluent from the case
- Remove the gray cap from the vial
- Remove the cap from the syringe
- Do not remove the plastic clip from the syringe, as this may allow the push rod to come out of the syringe
- Insert the needle tip in the center top of the rubber stopper on the vial and slowly push the diluent from the syringe into the vial
- Gently swirl the vial with the syringe still in the vial until the solution is clear (this takes about 10-15 seconds)
- Glucagon should not be used unless the solution is clear and of a water-like consistency
- Turn the vial upside down, being sure that the needle does not fall out of the vial
- Pull the solution into the syringe, by pulling back on the plunger, as you withdraw the ordered amount of glucagon solution
- If present, remove air bubbles by tapping on the outside of the syringe and expelling the air or by pushing the dose back into the vial and pulling back on the plunger again
- Identify the location (buttock, thigh, or arm) for the injection
- Cleanse the injection site with an alcohol wipe
- Insert the needle into the skin at a 90-degree angle
- Slowly inject the solution
- Remove syringe
- Put the used syringe in the carrying case
- Close the carrying case to avoid a possible needle stick injury
- Apply pressure using the alcohol wipe and gently massage injection site
- If the student is not lying on their side, move the student to a side-lying position because vomiting often follows the injection of glucagon
- If needed, ask another person for assistance
- If alone with student, and you have not already called 911 or emergency medical service, do so now
- Monitor the student’s arousal, pulse and respirations
- If breathing stops, move the student onto their back
- Begin rescue breaths
- If breathing and heartbeat stop, begin CPR
- As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
- Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
- Send along glucagon kit along with used dose
- Dispose of all used materials in proper receptacles
- Remove gloves and wash hands
- Follow up with the parent or guardian and healthcare provider, as needed
- Document medication administration in the student’s medication administration log
References
American Diabetes Association. (2015). Hypoglycemia (low blood sugar). Retrieved April 15, 2020, from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html.
Levitsky, L.L., & Misra, M. (2020). Hypoglycemia in children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved: April 16, 2020.
Lilly. (2018). Step by step instructions on how to inject Glucagon. Retrieved April 23, 2020, from https://www.lillyglucagon.com/taking-glucagon/how-to-inject.
National Association of School Nurses. (2016). Diabetes management in the school setting (Position Statement). Silver Spring, MD: Author. Retrieved April 30, 2020, from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-diabetes.
National Diabetes Education Program. (2016). Helping the student with diabetes succeed: a guide for school personnel. Retrieved April 30, 2020 from https://www.niddk.nih.gov/-/media/Files/Health-Information/Health-Professionals/Diabetes/health-care-professionals/NDEP-School-Guide-Full-508.pdf?la=en&hash=96CB5BC79927D61084D4EAEF5577FCFC. Retrieved: April 23, 2020.
Page last updated: March 15, 2021
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.