Diabetes Emergency Action Plan for Paul Laurent

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Diabetes Emergency Action Plan for Paul Laurent

Diabetes Emergency Action Plan for:____________________Emergency Contact Information (Call in this order)Nurse: (919)228-4562 or Cell #: (919)302-8210Parents:Phone Numbers:Signs and SymptomsSigns in ________vary, and mayinclude: Quiet, not focused, sleepylooking, poor concentration Very grouchy and mean Very hungry Inappropriate emotionalresponses (i.e. uncontrollablysilly, hyperactive Headache or dizziness Face looks paleSigns and Symptoms__________ has never hadModerate Hypoglycemia, but hereare some of the possible symptoms,just in case: Staggering walk Uncontrollable crying episode Slurred speech Blank stare Refusal to take anything bymouthDiabetes Emergency ProceduresMild HypoglycemiaModerate HypoglycemiaTreatment______ will handle mild hypoglycemiawithout assistance. If you ever see signs ofhypoglycemia in ______ , simply ask him totest his blood sugar.Never send ________ to the Nurses office ifyou suspect that he has a low blood sugar. Ifyou need help, send someone else for thenurse.Treatment Moderate hypoglycemia is handled like mildhypoglycemia, with the followingexceptions:If _______ is unable or unwilling to takecarbohydrates (he may become irrationalor uncooperative and may not be able tofollow directions), slowly squirt an entiretube of cake icing (found in his ) inbetween his cheek and gums – even if heresists. This may require assistance.Rub the cheeks gently to make sure thesugar is absorbed.Check Blood Sugar again _____ minutesafter treatment, and retreat if necessary._____ should not be allowed to playsports or be highly active for the nexthour after a Moderate Hypoglycemia.Notify __________’s parents as soon aspossible.


Signs and Symptoms_______ has never had SevereHypoglycemia, but here are someof the possible symptoms, just incase:UnconsciousUnresponsiveConvulsion-like movementFailure to respond to ca-e icingSevere HypoglycemiaThis is a Medical Emergency!Treatment Be sure _______ is lying down in a safe area,protected from head or bodily injury. Position _______ on his side. Call 911. Inject Glucagon (get help from the nurse) Do not attempt to put anything between_____’s teeth.As ______ regains consciousness, nauseaand vomiting may occur.Notify __________’s parents immediately.Signs and Symptoms________ does occasionallyexperience Hyperglycemia.Symptoms vary, and may include: Increased thirst Frequent urination Sluggishness Stomach Ache Headache Fruity Odor to the BreathHyperglycemiaTreatment _________ will handle any treatment of mildto moderate Hyperglycemia with minimalinterruption to his school activity. He cancalculate his insulin requirements with noassistance. If Blood Sugar (BS) is above ______, hemay need to go to the nurse’s office. Write plan here____________________ These supplies are kept in the nurse’s office. ______ needs free access to the bathroomand water fountain, especially duringhyperglycemia.Reviewed and Signed: _______________________ _________ParentDate_______________________School Nurse_______________________Doctor_________Date________Date

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