Glucagon training help!!

[J-lynn]

I am a new public school nurse and have never worked with type 1 diabetics before. I will need to do glucagon training soon and the question has come up as to whether to test or not before giving the glucagon.

Our lead nurse has said no, we don't test first. But my husband who is a physician says that teenagers are more likely to be in DKA than hypoglycemic.

Thoughts on how you would train teaching staff, and what you would do yourself?

I will be working with a fourth grader in one school and with high school students as well.

[OldDude]

If I have a known diabetic who is unresponsive or unable to communicate with me, absent of another obvious reason for that condition like a head injury, I'm going for the glucagon and initiate basic life support until EMS arrives...in hopes that the glucagon was what he/she needed. If they come back to being awake and able to communicate with me I'll test for BG. I wouldn't worry too much about giving glucagon, under similar circumstances, to someone in DKA...that extra glucose likely won't significantly worsen that condition that quickly...EMS will be on the way.

I have mixed emotions about training staff. In Texas we are required to have at least one person other than the school nurse trained in diabetes management on campus. Our local Education Service Center offers two classes a year in this regard. Generally, what I've seen, is the staff receiving the training just don't have the critical thinking skills to independently manage Type 1 diabetes day in and day out...much less in a diabetic emergency. I would be very hesitant to attach my RN license certifying an unlicensed staff member's competence.

If outside training programs are not available to you I think what I would do is make sure you get a detailed diabetes management plan from the student's MD and use that as your "training" material. You could attest that the staff "demonstrated understanding" of the MD generated plan.

[J-lynn]

Thanks so much for the response. I was thinking much the same about giving the glucagon. The question came up in a 504 meeting today & I told the mom that no, we would not test first if her son was unconscious because I wouldn't want to delay treating a possible hypoglycemic episode.

Then I get home & my husband who is a physician in the ER says they test quickly first. So I immediately questioned my thinking on it, of course. So grateful for all the experienced nursing advice on this forum!!

There are some EMT's (or former EMT's) on our quick response team that I will need to train. I don't know what their protocol is & am not sure if they will really question me on it.

[KelRN215, BSN, RN]

I don't work in a school anymore but I have a diabetic child on my caseload who just got placed with new foster parents and the DNE taught the new foster parents to check the blood glucose before giving glucagon if he ever passes out or has a seizure.

[J-lynn]

Thanks! Maybe there are a variety of opinions on this? Still confused on how to handle it for sure....

Our lead nurse said not to check. She is on maternity leave right now & me being new, I don't want to cause a problem by asking someone else..

[J-lynn]

So I finally found on one of our glucagon information sheets that for mild symptoms of hypoglycemia that we check first, but for moderate symptoms we treat without checking. For severe symptoms just give the glucagon. So now I have it in black and white from our district's nursing documents. Maybe that will change in the future....

[aprilmoss]

As the mother of a rather brittle diabetic, the answer is if the kid appears severely hypoglycemic, go ahead and give the glucagon (if the kid isn't coherent enough to try a glucose pill or the old maple syrup trick). Severe hypoglycemia is an "time is of the essence" condition. DKA is typically not. Even if the kid is in DKA or way high on his bg, the glucagon isn't going to hurt him. If the kid was hypoglycemic, this should bring him around. If not, you're going to have to 911 him anyhow (either hypoglycemic or DKA). You can do a bg test while you're waiting for the ambulance.

Also understand that glucagon is a last ditch, one shot. So you need to either get glucose into the kid by mouth (if he's conscious) or get the IV going, so my policy is to 911 even when I'm giving glucagon. (We don't have D50 in our clinics, and I'm not authorized to give it even if we did).

[Jedrnurse, BSN, RN]

Since glucagon takes 10 - 15 minutes to take effect, I push for only giving it if a kiddo can't take oral quick-acting carbs. If the child is unresponsive or seizing, (just try to get a fingerstick on a seizing child BTW ) I'm not waiting to test. I'll give the shot and call 911.

[J-lynn]

Thank you!!!

[J-lynn]

Thank You!!

[SICUMURSE1]

interesting, colleague of mine went through same thing

[Neats, BSN]

When I was an Army Nurse in Massachusetts to earn extra monies I worked part time at Joslins Diabetic Hospital. The off shoots from this hospital in some areas of the countries is called Humphries (in the northwest). I am only 2 family members on my fathers side that does not have diabetes. I had 2 aunties and numerous cousins. All have been diagnosed at an early age (around 2 years old). My father bless his heart died form Diabetes complication when he was only 42. He did not take care of himself very well.

I think it is a good ideal to check I would, just for the reason your hubby says.

Additionally I would give all students and parents the following email website for Diabetes ongoing questions and to learn more about the disease:

Pediatric Diabetes Services | Joslin Diabetes Center

I have given Joslins numerous tissue/blood samples as well as most of my cousins and aunties. Hopefully one day there will be a cure for this disease.