/clinical/,/clinical/pted/,/clinical/pted/hffy/,/clinical/pted/hffy/pediatric-diabetes/,

/clinical/pted/hffy/pediatric-diabetes/1102.hffy

201612363

page

100

UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Pediatric Diabetes, Endocrine

Pediatric Diabetic Teaching Guidelines/Checklist (1102)

Pediatric Diabetic Teaching Guidelines/Checklist (1102) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pediatric Diabetes, Endocrine

1102

Pediatric Diabetic Teaching Guidelines/Checklist


This teaching guideline contains the essential elements for teaching pediatric inpatients with diabetes. All teaching and patient/family
responses should be recorded on the Pediatric Patient Teaching Diabetes Addendum.
CONTENT OUTLINE COMMENTS TEACHING RESOURCES
1) Diabetes: An introduction
 What is Diabetes? Page 9
 Review pathophysiology
 Types of Diabetes and causes
 IDDM (Type 1) – Page 15
 NIDDM (Type 2) – Page 21
 (Discuss Differences)
 Normal blood glucose levels for non-
diabetic
 Factors that influence glucose levels:
Illness, exercise, insulin doses, food
intake, hormones (growth, sports,
menstruation) Page 48
 HgbA1C in relation to level of glucose
control Page 152
 Goal for diabetic patient Page 151
Toddlers/Preschoolers (6yrs or
younger) - less than or equal to
8.5 (but greater than or equal to
7.5%)
School-age (6yrs to 12yrs) - less
than 8%
Adolescents/Young Adults (13yrs
to 19yrs) less than 7.5%
(Goals should be individualized and lower
goals may be reasonable based on benefit:
risk assessment)the 12th edition of Pink
panther is the most current. This is what is
stated, but it is not per current ADA
recommendations.
Goal hemoglobin A1C: < 7.5% Per ADA
2015
 Honeymoon period – Page 12

(Page numbers in left column
refer to Pink Panther 12th
edition: Understanding Diabetes)

Inpatient nurses will order all
supplies needed for discharge on
patient admission so they should
be available for LC teaching
sessions in patient room.
Pink Panther: Understanding
Diabetes 12th edition. H. Peter
Chase, MD
Companion book for 12th edition: A
First Book for Understanding
Diabetes.












2) Blood Glucose Monitoring – Page 51
 Discuss purpose of a glucose meter.
Safety and improved control
 Using lancet to provide “finger stick”
sample – Page 53-54
 Remind to wash hands with soap
and water rather than using alcohol
wipes or waterless hand sanitizer
(i.e. Purell®)
 How to apply sample to strip – depends
on meter
 Proper timing of procedure Page 56-58
 AC, HS, & (initially 0200), & PRN
for first month
 Coding if needed
 How to check strip/control solution, &
frequency of controls
 Check weekly & when opening new
strips or when troubleshooting
meter
 Cleaning of meter
(Determine type of meter based on
insurance: For assistance:
Is this process correct Karen or
Deb?
---Pink Panther text pages 53-54




---Pink Panther text pages 53-54

---(See individual meter’s user
manual)

---(Goal is to demonstrate to parents
and then have them practice on
themselves, progressing toward
independent measuring and
recording of child’s blood glucose
levels on their own.)

---(Order extra meter from CS)


CONTENT OUTLINE COMMENTS TEACHING RESOURCES
 Trouble-shooting
 Not enough blood
 Battery
 Coded correctly
 Testing at home, school, daycare, etc.
 Recording results in “Bucky Badger”
logbook – bring to appointment

Meter specific instructions in box.



***Note hospital policy states that
we must still document all blood
glucose levels using UWHC meter.*
3) Insulin Injections
 What is insulin? Page 65
 Types of insulin Page 66 (introduce the
types that the patient will be taking)
 Onset of each type
 Peak of each type
 Duration of each type
 Dosages and schedule patient is
currently on
 Side effects of insulin
(hypoglycemia)
 Insulin storage and expiration Page 86
 Drawing up 1 type of insulin
Page 80-81
 Glargine (Lantus®) cannot be
mixed with other types of insulin
 Drawing up & mixing 2 types of insulin
Page 80
 Air into NPH, Air into Regular or
Aspart®
 Then draw up Regular or Aspart®
followed by NPH (Do not mix long
acting insulin into short acting vial)
 Injection sites & rotation Page 79
 Rotate sites; suggest using the same
site for the same time of day from
one day to next. (Ex} each am use
arms, pm use legs, HS use abd, etc.)
 How to give SQ insulin Page 82-83
 How to record dosage (in “Bucky
Badger” logbook)
 What to do if you miss a dose
 Call MD
 Expect dosages to be adjusted by
MD/NP to establish better control over
time. “Honeymoon Period” (p. 12)


---Pink Panther text Chapter 8

---Pink Panther pages 65-75 (helpful
table page 70)









--- (Parents to demonstrate drawing
up and administering insulin. May
choose to draw up sterile water and
practice injections on practice balls,
fruit or on themselves.)

4) Carbohydrate Counting/Diet
 Types of meal planning
 Constant Carb Meal Plan
 Carb Counting Meal Plan
 Exchange Meal Plan

Have nurses page Dietitian to meet
with patient and family.

---Pink Panther Chapter 12
(Also reference dietary section in
Diabetic education binder.)
(Order low and “no” carb snacks for
patient’s own floor stock to be used
as needed when child wants a snack
but blood glucose levels are elevated.
See dietary list of low/”no” carb
snacks.)




5) Hypoglycemia/Hyperglycemia
 What does hypo/hyperglycemia
mean? – Chart Page 58
 Review suggested glucose goals – Page
151
 ADA 2015
 Before meals BG 90-130
 Bedtime/overnight BG 90-150
 (this may be individualized per
endo md)
 Signs & symptoms of
hyperglycemia/Acidosis
Fasting less than 240 or non-fasting
Value greater than 300
 Causes & treatment of hyperglycemia,
Page 290
 Illness/stress/carbohydrates/missed
insulin, etc
 Treatment-insulin
 Signs and symptoms of hypoglycemia
Page 38
 Causes of hypoglycemia
 Missed meals/snacks
 Too much insulin
 Illness, exercise, etc. (May have
delayed hypoglycemia following
very active periods. On these days
eat extra carb/protein snack before
bed, check BS at 0200. Also should
call MD to adjust insulin in
anticipation of active days.)
 How to treat hypoglycemia
 Carbohydrate choices - Rule of 15,
Page 41
 Glucagon for emergencies (discuss
in next section)
 Recognizing low blood glucose
reactions with friends/school/daycare
Page 39
 Prevent
 Be prepared: Carry carbohydrate
with you
 Teach others
 Rationale for Medic Alert Bracelet and
ordering information. Also available in
AFCH gift shop.
Page 47-48 Pink Panther


---Pink Panther text Chapter 6







---Pink Panther text Chapter 15
































6) Glucagon Pages 45-47
 What is glucagon?
 Purpose
 How it works
 When to use it
 Unable to take anything by mouth
 Loss of consciousness
 Seizure caused by low blood
glucose, reinforce to give Glucagon
even if parent is shaken up from
seizure.













 What dose is appropriate for your
child, page 44 but per MD.
 < 5 years = 50 units (0.5mL)
 > 5 years = 100 units (1.0mL)
 How to mix and inject glucagon SQ or
IM as recommended by our endocrine
staff, page 46 (giving glucagon SQ
prevents confusion for families since they
already administer insulin SQ) can give
through clothes in emergency.
 Side effects
 Nausea, vomiting
 What to do after giving glucagon
 Check blood glucose level, roll to
side if risk of vomiting, call 911-
unless patient is awake and family is
comfortable with situation. Inform
family that it may take 10 to 15
minutes to work.
 Use of glucagon in school, etc. page 255






---Demonstrate with sample
glucagon kit (available in cupboard
where diabetic teaching materials
are kept, or obtain through endocrine
staff.)
---Have family verbalize how and
when to administer.





7) Sick Day Management: HFFY 5647
 How illness effects glucose levels
 Effects of minor illnesses (cold, sore
throat) on blood glucose levels
 Need for increased monitoring
 Types of fluids and foods to drink/eat
 If unable to eat, replace carbs with
liquids and soft foods containing
sugar to prevent body from
producing ketones (even if BS is
elevated)
 Use of over the counter medicine with
illness
 May use as needed
 Ketoacidosis Pages 160-161
 What is it?
 How to check urine for ketones
(every 4 hours when ill)
 Watch ketostix bottle for expiration
date (6 months after opening)
 Insulin adjustment for sick days
 MD/NP to help determine this,
CALL early with questions
 MOST IMPORTANT!! KNOW HOW
AND WHEN TO CALL MD IF SICK:
 608-263-6420 ext # 3 or 608-262-
2122 to page Pediatric Diabetes
MD on-call
 As a general rule, should always
call MD if sick—esp. if vomiting

Supplemental teaching:

Can give list of family diabetes materials.

JDRF Backpack
Ask family to fill out the bag of Hope Form and
mail back in self addressed/stamped envelope.
Inform family about ADA diabetes camp, give
camp registration handout.
Uwhealthkids.org/diabetes
Please review HFFY 5647 for all
families. This is more concise and
specific to AFCH than Pink
Panther book.


--Sick day guidelines for children
with diabetes HFFY 5647


---Pink Panther Chapter 16 Page
167-168
















Order Ketostix prior to teaching.
Demonstrate use with actual bottle of
ketostix.






8) Discharge Planning
 Telephone Numbers to Call:
 Peds Diabetes Office: 608-263-6420
ext # 3
 Learning Center visit 2 week
 RTC in 4-6 weeks
 visit with NP
 RTC 3 months visit with diabetes
MD provider
 Check with MD to see if family should
call results of blood glucose levels in to
MD following discharge, prior to follow
up appointment (Sometimes MDs prefer
that results are called in on certain days
following initial days at home).
 Have prescriptions for all diabetes
supplies (insulin, syringes, lancets, strips
glucagon, etc.) sent with patient to take
to local pharmacy for ease of refilling.
 This is no longer the current practiceIf
school-age, have MD complete school
orders on HL and give signed copy to
parent
 Additional discharge supplies:
 3 gallon sharps container
 Sharps Instruction HFFY
 1 qt sharps container for travel
 alcohol swabs
 blood glucose monitor with
adequate lancets and strips
 adequate starter syringes
 ketostix
 Etc. (See CS sheet as printed in
Diabetic education Binder.)
AFCH inpatient nurses to do
discharge teaching.
.






























--HFFY 4587

---School instruction templates
should be available in discharge
section of Diabetic materials binder.

---Also see discharge section of
binder for CS form template for
ordering DC supplies online, and
templates of prescriptions and DC
facesheet.






References:
American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. Supplement 1: S15-35, 2005 January.

Chase, H. P. (2011). Understanding Diabetes (12th ed.).





Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If
this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be
used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your
doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright 1/2016.
University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#1102