Supplies she keeps in her classroom
Supplies she keeps in the Health Office
Type 1 Diabetic – Insulin Dependent – Uses an Insulin Pump
In Emergency call 911
We prefer Summit Healthcare in Show Low or
Cardon Children’s Medical Center – Mesa, AZ
Blue Cross Blue Shield of Arizona
Subscriber # XBP 850987661 (Brian Silverhorn)
Amanda Silverhorn (mom) – ###-###-####
Brian Silverhorn (dad) – ###-###-####
Brian Work – Show Low Motorsports – ###-###-####
Linda Prentice (Grandmother) – ###-###-####
Brandon Silverhorn (Uncle) – ###-###-####
Endocrinologist – Dr. Joel Hahnke (Southwest Pediatric Endocrinology)
###-###-#### fax ###-###-####
Diabetes Educator – Jeanette Larsen (Show Low Hospital)
Kortnie Silverhorn has Type 1 Diabetes
What is it? This disease occurs when the body’s immune system attacks and destroys the insulin producing beta cells located in the pancreas. Insulin is a hormone that helps the body move glucose (sugar) contained in food into cells throughout the body. The cells need glucose for energy. When the beta cells are destroyed, no insulin can be produced and glucose stays in the blood instead. If glucose stays in the bloodstream, it can cause serious damage to all the organ systems of the body.
What does it mean for you? The important thing to remember is that Kortnie is a healthy, happy, normal child. Caring for her requires a little extra knowledge to get her through each day safely with good blood sugar control.
What is the treatment? Kortnie receives Insulin via in Insulin Pump 24 hours a day. (Every 3 minutes she receives a small amount of Insulin automatically, and then when eating or experiencing a High Blood Sugar, she can manually give herself a dose of insulin via the pump) This type of therapy requires frequent blood sugar checks. I will check her first thing in the morning and when she’s dropped off at school. You will need to send her to the Health Office 5-10 minutes before lunch, she and Miss Sharon will check her blood sugar and administer insulin via her pump for her lunch. Occasionally she will have to go back to the Health Office for a check after lunch. (Kortnie or Miss Sharon will let you know if this needs to happen) Also, Kortnie will have her meter with her at all times in the classroom. She needs to be able to check her blood sugar at any time she feels the need. Also, if she is acting out of character or you are concerned you can have her check. Her blood sugar goal range is 80-140, but 80-175 is an acceptable range as well.
Special Classes or Activities –
PE- Physical Activity can make her blood sugar drop, she should bring her meter and a source of sugar to PE class – glucose tabs or juice box
Fire Drill- She should bring her meter with her when exiting the building for a fire drill, also the Teacher, Kortnie or another Student should get into the habit of bringing her Classroom Emergency Kit as well.
Lockdown- In the event of a Lockdown, please try to make sure that she has her testing supplies as well as a source of sugar (juice box, glucose tabs, Smarties, any kind of candy) available to her.
Field Trips, Track and Field Days, etc.- Please let mom know as far in advance as possible for these types of days, mom or dad will make arrangements to accompany Kortnie on field trips and or to be present at Track and Field days and class parties where food is served.
Other Special Accommodations
Kortnie’s insulin pump is connected by a tube that goes into her belly or arm, the actual pump she wears either clipped to the waistband of her pants, in her pocket, or in a fanny pack around her waist.
Please let all Substitute Teachers know about Kortnie. If possible let Kortnie know if you are going to have a scheduled absence. In the case of a long term sub, I’d love the opportunity to have a meeting with him/her.
Please let special teachers and the other 3rd Grade teachers know about Kortnie’s condition.
Kortnie needs access to the restroom and nurse’s office at all times. (Exception of course would be in a lock down situation)
She should always be able to check her blood sugar when she feels the need.
We will provide a kit in the classroom and nurse’s office with things she may need, sources of sugar, extra test strips, extra batteries, emergency glucagon shot, alcohol wipes, extra lancets, etc. If you are running low on anything (usually sugar sources), please let me know. I’ll send in replacements with Kortnie on the next school day.
If having a class party, where food will be present, please let us know and we will make arrangements for her to participate. ** She cannot have regular soda or juice (except in the case of a low blood sugar), if having these items at a party, I can send in diet soda or crystal light.
For Aims testing we will need to make sure her blood sugar is within range before starting the test, as Aims testing draws nearer we should plan a meeting to discuss testing accommodations.
If Miss Sharon is having a planned absence she will let us know, if she has a last minute absence someone at the school should call mom and let us know.
Always feel free to call mom or dad with any questions or concerns!
Emergency Situations- Everyone caring for Kortnie (including special teachers and substitute teachers) must be aware of low and high blood sugar signs and notify the school nurse or designated persons promptly, so that Kortnie’s blood sugar number can be checked and then treated accordingly.
Low Blood Sugar- The only emergency that could come on quickly is LOW BLOOD SUGAR. This can occur if she gets more exercise than usual, does not eat her full meal, or receives too much insulin, is ill, or is stressed. The warning signs of low blood sugar vary, but include any of the following: hunger, paleness, sweating, shaking, eyes that appear glassy, dilated (big) pupils, personality changes such as crying or stubbornness, headaches, inattentions, drowsiness, weakness, irritability, confusion, speech and coordination changes. IF NOT TREATED -> LOSS OF CONSCIOUSNESS, SEIZURE, BRAIN DAMAGE, OR DEATH CAN OCCUR.
*WHEN KORTNIE IS LOW- She can look pale, have glassy eyes, her hands may be shaky, and she may seem confused, irritable, crying for little to no reason, or extremely tired.
Treatment for LOW blood sugar: Give SUGAR to help the blood sugar rise. Juice boxes, Glucose tablets, and Smarties will be kept in the nurse’s office and your classroom.
**If blood sugar is less than 75 -> Give 3 glucose tablets, 1 package of Smarties, or 1 juice box (other sugar sources could be pixie sticks, sugar packets, non-diet soda). After treatment, wait 15 minutes and re-check the blood sugar. Kortnie should not eat anything else at this time as other foods can slow the absorption of sugar into her system. If her blood sugar is still less than 75 repeat the steps.
LOW BLOOD SUGAR GUIDELINES
75-85 – Give 1 glucose tab or ½ package of Smarties
60-75 – Give 3 glucose tabs, 1 juice box, or 1 package of Smarties, recheck in 15 minutes
59 or less – Give JUICE – send to Nurse’s office with her meter – SEND HER WITH A BUDDY – at this point she may be shaky and/or confused, never leave her alone.
50 or less – it’s better to call Miss Sharon to come to your class
**if the meter says “LO”-give juice, call mom, and call Miss Sharon, standby with Glucagon
If UNCONSCIOUS OR HAVING A SEIZURE/OR UNABLE TO TAKE SOMETHING BY MOUTH:
1. Give Glucagon (medication in red container) inject ½ into the front of her thigh
2. Have someone call 911 and then parents
3. Roll Kortnie onto her side as this medication may cause vomiting
4. Wait 10 minutes, if not conscious inject other 1/2 of medication
High Blood Sugar: People with diabetes may have high blood sugars and spill extra sugar into the urine on some occasions. These occasions include periods of growth, stress, illness, overeating and/or lack of exercise, or certain medications. High sugars are generally not an emergency (unless accompanied by Ketones, abdominal pain, vomiting, or if they persist for a prolonged period of a few hours). High blood sugar signs include:
1. MILD: Thirst, frequent urination, sweet smelling breath
2. MODERATE: Dry mouth, nausea, stomach cramps
3. SEVERE: Labored deep breathing, extreme weakness, confusion, and eventually unconsciousness (coma)
*When Kortnie is HIGH- She can have a headache, be thirsty, have to use the restroom often, and at times she can get very angry and/or throw a fit.
Treatment for HIGH blood sugar: Call parents for blood sugar greater than 350. Extra insulin may need to be given by the School Nurse. Kortnie will need to drink sugar free fluids (water) and urinate more frequently. Please allow her to consume as much water as she wants and make bathroom privileges readily available.
High Blood Sugar Guidelines
250 or above – Send her to nurse’s office with meter, she may need an extra dose of insulin, recheck in 1 hour to make sure she is coming down
350 or above – Send her to nurse’s office WITH A BUDDY (If she is aggressive or disruptive, have Miss Sharon, another adult, or you yourself take her out of the class.
**If her meter says HI** she is above 600- call parents immediately – call Miss Sharon to come to the class – try not to remove her – if she is “out of control” or disruptive it may be better to remove the other students
When to Check Blood Sugar? 5-10 minutes before lunch, send Kortnie to the Nurse’s office with her lunch box and test kit. She and Miss Sharon will calculate and dose her lunchtime insulin, she will then join her class in the cafeteria. Kortnie will keep her meter and test kit with her at all times, she needs to be able to check her blood sugar anytime she feels the need. If you feel like she is acting out of character or exhibiting sings of low or high blood sugar you may ask her to check her blood sugar at any time.
If she ever complains about not feeling good please let her check her blood sugar or go to the Nurse’s office. If she falls asleep in class, please try to wake her and have her check her blood sugar, chances are she is LOW. If she is crying for no reason, or seems really angry, she is most likely having a LOW or HIGH blood sugar and will need to be checked. Anytime she is disrupting class please call Miss Sharon or another adult to take her out of class and call me.
ANYTIME HER PUMP ALARMS HAVE HER GO TO THE OFFICE AND CALL PARENTS
What should Kortnie eat or not eat? I will pack Kortnie’s lunches and label the items with carb counts. It is extremely important that Kortnie eats all of the lunch I pack for her. If she does not eat all of the food she was given insulin for she could become low within the following couple of hours. She knows that she needs to eat all of her lunch, but if for some reason she doesn’t finish it, she’ll need to go to the Nurse’s office and call me. I can help her and Miss Sharon figure out what we need to do to compensate for the food she didn’t eat. If she brings a snack for recess, it will be a “free” snack that she is allowed to eat without insulin. Such as a slim jim, cheesestick, peanuts, or sugar free jello. Also, it is important that Kortnie is not given food without the School Nurses or parents knowledge…she would need extra insulin or she can have a high blood sugar in the next couple of hours. If there are any special class parties where food will be involved, please let me know a couple of days in advance and I will most likely come down and help in the classroom so that Kortnie can fully participate. If other children bring birthday treats at the end of the day, she can bring her treat home and have it for an after school snack. If you hand out treats as rewards, she can collect them in a zip lock type bag and bring them home for her after school snack, or in lieu of treats you can give her stickers, or something similar. **Last year she and her teacher got into the routine of checking her blood sugar, then using the teacher’s cell phone to call me and I could talk her through giving herself a bolus of insulin when having treats** This worked out well, if you are wanting to do something similar we are up for it.
What to expect from parents? I (Amanda-mom) will always have my cell phone on my person and am fully expecting calls from school. My phone number is ###-###-####. If you can’t get ahold of me feel free to call her dad Brian ###-###-####. Her emergency phone list is on the first page, just go down the list. Also, I will accompany her on all field trips and participate in the end of the year Track and Field Day. Please let me know as far in advance as possible so I can make arrangements for my other children if I need to, etc. I will provide sugar sources for her, please let me know if/when you are running low on supplies. Always feel free to call me with any questions! Also, feel free to email me with non-emergent questions, class party schedules, or field trip information. firstname.lastname@example.org
When to call parents
When blood sugar is less than 60 or higher than 350
Questions on carbohydrate counting
When Kortnie is sick
When her pump is alarming
If the pump becomes disconnected or her site rips out
If Miss Sharon is not at school
If Kortnie is ever disruptive
With ANY concern at all
1. Check Blood Sugar
2. On Meter/Remote BOLUS will be highlighted, press OK
3. Use down arrow key to highlight EZCARB, press OK
4. Add in total carb count using up arrow key, when total is input press OK
5. ADD BG will be highlighted, press OK
6. Blood Sugar # should be showing, press OK (if not use up or down arrow keys to input blood sugar number, press OK
a. If a high or low blood sugar was input, you may get a Pump Alert screen, CONFIRM will be highlighted, press OK
7. SHOW RESULT will be highlighted, press OK
8. Look on 4th line where it says TOTAL = xxx, this is the total number of insulin units to give Kortnie
9. Use the up arrow to put in total number, press OK
10. GO will be highlighted, press OK and insulin will be delivered
When High Blood Sugar
1. Check Blood Sugar
2. On Meter/Remote BOLUS will be highlighted, press OK
3. Use down arrow key to highlight EZBG, press OK
4. Blood Sugar # should be showing, press OK (if not use up arrow keys to input blood sugar number, press OK)
a. If a high blood sugar was input, you may get a Pump Alert screen, CONFIRM will be highlighted, press OK
5. SHOW RESULT will be highlighted, press OK
6. Look at the 3rd line where it say TOTAL = xxx
7. Use up arrow key to put in TOTAL number, press OK
8. GO will be highlighted, press OK to deliver insulin