<< ENDOCRINE
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.
- Based on the student’s Diabetes Medical Management Plan/health care provider’s order, low blood sugar is treated with some type of quick-acting oral sugar, such as candy, icing/cake frosting tube, and/or juice.
- Severe low blood sugar symptoms include disorientation, unconsciousness, and seizures. If not treated promptly it could lead to death.
- Glucagon is a medication used in emergency situations when the student is unresponsive or unable to swallow because of very low blood sugar.
- Given that when a student is having symptoms of severe low blood sugar, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s emergency plan beforehand.
- The school nurse or other qualified health care professional must review the glucagon procedure with staff to ensure that they have the skills to perform this emergency medication administration.
- Store the Diabetes Medical Management Plan/health care provider’s order and glucagon in a location that is easily accessible during a severe blood sugar event.
- Be sure that staff members who have regular contact with the student know where the medication is stored.
- If the student self-carries their glucagon be sure to communicate with the student to know where they store their medication.
- The school nurse should develop a plan to systematically check the expiration date on medication to ensure medication is not expired.
- Remember to keep the student’s health care information confidential.
Important storage information:
- Do not remove the shrink wrap or open the tube until you are ready to give the medication
- If the tube has been opened, BAQSIMI could be exposed to moisture
- This could cause the medication to not work as expected
Supplies:
- Baqsimi
- Gloves
- Healthcare provider’s order
- Diabetes Medical Management Plan
- Student’s Individualized Healthcare Plan (IHCP)
- Parent/guardian authorization form
- Bulb syringe, if available
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 six rights of medication administration and the order to be sure it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Be sure to check the medication to ensure that it has not expired
- Review student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer the medication
- Wash your hands, if possible
- Review the six rights once again to ensure that it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Put on gloves, if gloves are not available, continue with the procedure
- Look into the child’s nostrils to determine if there is fluid or mucus in the nostrils.
- If drainage or mucus is present, use a bulb syringe to remove it
- If bulb syringe is not available, medication can still be administered if drainage or mucus is present
- Remove the Shrink Wrap by pulling on the red stripe
- Open the lid and remove the device from the tube
- Caution—do not push the plunger until ready to give the dose
- Use your free hand to hold the crown of the head stable
- Hold the device between your fingers and thumb
- Do not push the plunger yet
- Insert tip gently into one nostril until your finger(s) touch the outside of the nose
- Push plunger firmly all the way in
- Dose is complete when the green line disappears
- Remove the device
- 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 and for potential seizure
- If student begins to seize, clear the area of anything hard or sharp, to prevent injury
- 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 BASQIMI 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. (n.d.). Hypoglycemia (low blood sugar). Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia
American Diabetes Association. (n.d.). Medications and treatments. Glucagon and other emergency glucose products. Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/glucagon-other-emergency-glucose-products#:~:text=Glucagon%E2%80%94a%20hormone%20that%20raises,you%20in%20case%20of%20emergencies
Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Retrieved June 6, 2023, from https://www.cdc.gov/epilepsy/about/first-aid.htm
Eli Lilly and Company. (2020). Baqsimi-glucagon powder. Retrieved June 5, 2023, from https://uspl.lilly.com/baqsimi/baqsimi.html#ug
Eli Lilly and Company. (2020). How to use BAQSIMI . Retrieved April 15, 2020, from https://www.baqsimi.com/how-to-use-baqsimi.
Levitsky, L.L., & Misra, M. (2022). Hypoglycemia in children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved: June 2, 2023, from https://www.uptodate.com/contents/hypoglycemia-in-children-and-adolescents-with-type-1-diabetes-mellitus
National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8
National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660
National Diabetes Education Program. (2016). Helping the student with diabetes succeed: a guide for school personnel. Retrieved June 2, 2023 from https://diabetes.org/sites/default/files/2020-02/NDEP-School-Guide-Full-508.pdf
Wyckoff, L. (2019). Students with diabetes. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.). (pp. 575-602). Philadelphia PA.: F.A. Davis Co.
Page last reviewed: February 19, 2025
Page last updated: February 19, 2025
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.