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Chapter 18 | Endocrine Disorders 447

BOX 181 | Teaching Parents How to Inject Insulin—cont’d

HYPOGLYCEMIA LOW BLOOD SUGAR Cold, pale skin (cold sweat) Shakiness/hand tremors Sudden hunger (crave salt/sweet) Emotional outbursts (personality changes) Drowsiness/extremely tired Pounding heartbeat/palpitations Nervousness/dizziness Anxiety/irritability Headache, mental confusion, difficulty concentrating Numbness or tingling of lips/mouth Poor coordination/staggering unable to walk Slurred or slow speech Dilated, enlarged pupils Seizures or fainting (needs emergency treatment NOW )

HYPERGLYCEMIA HIGH BLOOD SUGAR

Increased thirst, even if consuming a large amount of liquids Loss of appetite, nausea/vomiting Weakness, stomach pains/aches

Heavy, labored breathing Fatigue, tired, often sleepy Large amounts of sugar in urine Ketones in urine Frequent urination Blurred/double vision

DATE 8/9/21 8/9/21

BLOOD GLUCOSE A.M.

BLOOD GLUCOSE P.M.

INSULIN DOSE GIVEN AND TIME

INJECTION SITE

GIVEN BY

124

4 units regular at 0700

Right midarm Left midthigh

Mom

144

4 units regular

Dad

4 units NPH 1230

From American Diabetes Association (n.d. a; n.d. b); National Institute of Diabetes and Digestive and Kidney Diseases (n.d.); Taylor (2019).

CLINICAL JUDGMENT Important Things to Teach Regarding Sick Day Rules M—Monitor blood sugar levels more frequently. D—Do not stop taking insulin. C—Check urine for ketones. B—Be careful with over-the-counter medicines. H—Have a game plan and don't hesitate to ask for help. F—Force fluids.

● Patient and family education regarding stress management or “sick day rules” (Sonawalla & Jafri, 2021). ● Patient and family education regarding blood glucose moni- toring (Fig. 18–4) ● Patient and family should demonstrate proficiency with glucometer. ● Discuss importance of monitoring blood sugar three to four times daily and keeping a blood sugar log with readings. ● Patient and family education regarding assessment of urine for urine ketones, especially when sick or under stress ● Patient and family education regarding how to manage hypoglycemia ● Preparing the patient and family for school guidance ● Preparing teachers and school administrators regarding insu- lin regimen of the child, sick day rules, monitoring of blood

FIGURE 184 Home monitoring requires parents to perform glucose checks on the child with diabetes.

glucose levels, signs and symptoms of hypoglycemia, and the administration of glucagon ● Emergency doses of glucagon and Gluco-Gel should be kept at home and at school if severe hypoglycemia occurs. ● Management of DKA ● Administer IV (typically normal saline) fluids and IV insu- lin as ordered. ● Correct acidosis and restore acid–base balance.