This presentation is authored by my good friend and colleague, Dr. Barb Schreiner. The presentation is for the Advanced Diabetes Seminar presented at Texas Lions Camp, Saturday, April 26, 2014.

1. Sailing around common diabetes
emergencies
Barb Schreiner, PhD, APRN, CDE

2. Navigate a diabetes emergency
• Correct the blood glucose
• Chase down the cause
• Consider what you learned

3. High BG, ketones, sick days
• 2 key concepts: fluids and insulin
• What ketones tell you
• Fluid management
• Insulin adjustments

4. Time Blood glucose Ketones What to do ?
7 AM 450 Large
9 AM 380 Large
12 N 350 Moderate
2 PM 260 Moderate
4 PM 346 Small
6 PM 230 Moderate
9 PM 180 Moderate

5. When would you call
the diabetes team?
Yes No,
not
yet
Situation
Gave 3 extra doses and child no better (still sleepy
and won’t drink)
Gave 2 extra doses, child drinking and eating well,
ketones coming down
Fever, won’t drink
Breathing hard, looks sick
Sore throat, blood glucose high but no ketones
BG high, no ketones, gave usual AM dose, now
child won't eat
Child vomited twice, BG normal, small ketones,
due for supper dose

6. Mini Dose Glucagon Rescue
for hypoglycemia during illness
• Check with your diabetes team
• Use for:
– BG less than 80 AND
– Stomach illness with nausea or vomiting
Age Initial Dose (glucagon drawn with an
insulin syringe)
2 years and younger 2 units (20 mcg)
2 to 15 years old 1 unit (10 mcg) for year of age
15 and older 15 units (150 mcg)

7. Mini Dose Glucagon Rescue
for hypoglycemia during illness
• BG may rise 60-90 mg/dl; last about one hour.
• When to repeat
• How to store unused
Age Initial Dose (glucagon drawn with an
insulin syringe)
2 years and younger 2 units (20 mcg)
2 to 15 years old 1 unit (10 mcg) for year of age
15 and older 15 units (150 mcg)

8. Finding patterns in the chaos
• What are your BG goals?
• When are BG levels out of target?
• Why are the BG levels out of target?
• How will you bring the BG levels back into
target?

9. When are levels out of target
Brk Lu Su Brk
AA BB CC DD EE FF
Brk Lu Su Brk
AA BB CC DD EE FF
Brk Lu Su Brk
AA BB CC DD EE FF

10. Why are levels out of target?
• Insulin
• Sites
• Growth
• Hypo
• Ketones
• Exercise
• Diet
• Life
• Technical