Diabetic Ketoacidosis Pathway - Children's Hospital Central California

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Diabetes DiaryINSULINBLOOD SUGAR TESTSDate Brk Lunch Din Bed Brk Lunch Din Bed NT Comments1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.28.29.30.31.Break A.M. Lunch P.M. Dinner Bed TimeCARBSCarb = 15 grams of Carbohydrates
Diabetes Education Check-ListMust be completed prior to discharge of NEW patientsInitials____ 1. Able to use blood glucose meter____ 2. Able to correctly draw up and administer insulin____ 3. Diabetes Diary filled out - parent understands how to keep____ 4. Demonstration of carbohydrate counting knowledge (and ability to recite meal plan ifappropriate)____ 5. Ability to recognize signs and symptoms of hypoglycemia and able to demonstrate how totreat - including when and how to use glucagon
Page 3 and 4: Diabetic Ketoacidosis Pathway - Adm
Page 5 and 6: Physician’s Signature/ID number :
Page 7 and 8: 1.0 .1 cc U IU µg MS TIW QD QID QO
Page 9 and 10: 1.0 .1 cc U IU µg MS TIW QD QID QO
Page 11 and 12: Fluidml/hrFluidml/hrFluidml/hrInsul
Page 13: Diabetes DiaryINSULINBLOOD SUGAR TE
Page 17 and 18: 4. Acidosis variable5. Anion Gap >
Page 19 and 20: is adequate, although there are the
Page 21: Dictation: 1-800-411-1001 (#963)D/S

Diabetic Ketoacidosis Pathway - Children's Hospital Central California

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