Dr. Prakasam, Dr. Nadgir, Dr. Skaria, Ms Carly Hammond PA-C
PENS team:
Rosanna Hannum CNS CDE, Lisa Metzger RN CDE, Geneva Foncannon RD CDE, Marisa Salas-Silva LCSW @1625 Stockton Blvd, Suite 112, Sacramento, CA 95816.
PENS POD 916 887-4818 or main scheduling 916 887-4832
PENS clinical questions: 916 887 4818
PENS Fax: 916 887 4822
PENS Fax: 916 887 4822
THE QUICK REMINDERS:
Save the following phone numbers (on the phone and on paper)
1. Pharmacy (s) and Back up 24 hour pharmacy
2. Endocrine office phone number (916 426 1902) and PENS team number
3. Pediatric/family doctor office phone numbers
4. Best friend/family back up number
5. Insulin pump/sensor support line number
Download or BOOKMARK
1. Glucagon injection or nasal spray
2. https://www.calorieking.com/
3. www.sackid.com
4. Your Pharmacy app
5. Pump &/or senor app
Everyday
1. Don’t nag your child, but get to know your child
2. Look for cues, to make your child’s life better
3. Make sure your child is safe and happy
4. Keep the family happy to the extent possible
Once a week
1. Have a picture taken of the pump settings every week and save it
2. Upload your latest pump and sensor data (SAVE Passwords)
3. Sit with your child weekly to review numbers & set goals/plan for next week.
4. Appreciate, be stern if needed but NEVER be mean, judgmental or punitive.
5. Acknowledge the hard work that you and your child are doing together
and give each other credit for it.
Once a month
1. Check all supplies weekly and order new supplies as needed (don’t forget ketone strips & glucagon)
2. Teach your child to get to the habit of checking supplies as they grow older
3. Revisit your approach – Remember we manage life and not diabetes – A simple SMILE can Make you and your child happy
4. Teach trouble shooting skills. Give diabetes related problem scenarios and go through solving the problem
5. Communicate with school nurse or school staff overseeing diabetes management at school
When your child is ILL
1. Talk to your family doctor/pediatrician and get appropriate advice
2. Keep your child hydrated
3. Check blood sugars and/or review the glucose sensors – at least every 2 hours
4. Make sure you check blood sugar one or two times during nighttime (ketones check if BS is >300)
5. There can be some insulin resistance during any illness – be prepared to give more insulin than usual, up to 1.5 times the standard dose.
6. Be prepared to use an insulin pen or syringes if blood sugars are not coming down as expected and you normally use a pump
7. When in doubt call us anytime! – TRY again in 5 minutes if you don’t get a call back!
8. Please let us know if your child will be absent from school right away so we can send a school note excusing absence that very same day
9. If your child continues to miss school or is being sent home repeatedly for because of ketones or blood sugar fluctuations we will need to see you for a f/u appointment earlier than scheduled
10. If your child cannot hold fluids go to the emergency room
How to give fluids?
1. If the child is drinking & NOT eating – provide un-carbonated fluids which have sugar in them, count the carbs & give insulin to cover the carbs. To avoid ketone buildup it is important the child has sugar & insulin.
2. If your child is drinking and eating – give sugar free fluids – sip by sip/tablespoon by tablespoon/teaspoon by teaspoon. Give insulin for carbohydrate containing food.
3. If the child is nauseous – give ice chips or use a straw for drinking water. Try sugar-free popsicles or sugar popsicles if the child is not otherwise eating.
4. Remember: insulin is as important as fluids during sickness
5. If the child is not holding fluids, take the child to the emergency room
6. Anti-vomiting medication (Zofran etc.) are only useful if we know there is no other reason for vomiting – remember appendicitis, UTI, intussusception can all present with vomiting
While Traveling
1. Have a checklist – keep the checklist in multiple places if needed, including the glove compartment of your car, your wallet, and always have the checklist on your phone.
2. Split supplies into two (carry on and checked baggage if flying)
3. Know the 24 hour pharmacy number in the vacation place and save the number
4. Keep a copy of all the insulin doses and pump settings (updated)
5. Travel note from your doctor for air travel
6. CHECK LIST: Back up long acting and short acting insulins, insulin pen, insulin syringes, needles, blood sugar meter, strips, glucagon, glucose gel/cake icing, pump supplies, updated insulin doses and pump setting
Pump or site failures
1. If blood sugars are high and stay high after a site change – site is usually bad
2. Site failures are more common than pump failures
3. Pump has a baseline delivery (basal) and delivery of bolus as needed (bolus)
4. The average total daily basal is your basal insulin (e.g. Lantus, glargine, levemir, basalgar) dose) Give it once a day or divide it into 2 doses and give 12 hours apart. (check the backup insulin for expiry date periodically)
5. Your short acting dose at time of food is the combination of your correction and insulin carb ratio
6. Check blood sugar every 4 hours and give short acting insulin, if not on pump.
7. Call the pump support line to trouble shoot
8. K-I-S-S protocol when blood sugars don’t come down after repeated bolus(K - check for ketones, I - injection of insulin to make sure insulin is going in, S - site change, S- sugar check an hour after doing KISS
Low blood sugars
1. If the child has seizures or unconsciousness, call 911 & give glucagon. No need to check blood sugar
2. If the blood sugar is low without loss of consciousness or seizures then, give glucose gel, cake icing or any sugary drink and follow the 15 minute rule
3. Don’t forget to look for reasons, why the blood sugar is low and it might be time to revisit and decrease the insulin dose.
Save the following phone numbers (on the phone and on paper)
1. Pharmacy (s) and Back up 24 hour pharmacy
2. Endocrine office phone number (916 426 1902) and PENS team number
3. Pediatric/family doctor office phone numbers
4. Best friend/family back up number
5. Insulin pump/sensor support line number
Download or BOOKMARK
1. Glucagon injection or nasal spray
2. https://www.calorieking.com/
3. www.sackid.com
4. Your Pharmacy app
5. Pump &/or senor app
Everyday
1. Don’t nag your child, but get to know your child
2. Look for cues, to make your child’s life better
3. Make sure your child is safe and happy
4. Keep the family happy to the extent possible
Once a week
1. Have a picture taken of the pump settings every week and save it
2. Upload your latest pump and sensor data (SAVE Passwords)
3. Sit with your child weekly to review numbers & set goals/plan for next week.
4. Appreciate, be stern if needed but NEVER be mean, judgmental or punitive.
5. Acknowledge the hard work that you and your child are doing together
and give each other credit for it.
Once a month
1. Check all supplies weekly and order new supplies as needed (don’t forget ketone strips & glucagon)
2. Teach your child to get to the habit of checking supplies as they grow older
3. Revisit your approach – Remember we manage life and not diabetes – A simple SMILE can Make you and your child happy
4. Teach trouble shooting skills. Give diabetes related problem scenarios and go through solving the problem
5. Communicate with school nurse or school staff overseeing diabetes management at school
When your child is ILL
1. Talk to your family doctor/pediatrician and get appropriate advice
2. Keep your child hydrated
3. Check blood sugars and/or review the glucose sensors – at least every 2 hours
4. Make sure you check blood sugar one or two times during nighttime (ketones check if BS is >300)
5. There can be some insulin resistance during any illness – be prepared to give more insulin than usual, up to 1.5 times the standard dose.
6. Be prepared to use an insulin pen or syringes if blood sugars are not coming down as expected and you normally use a pump
7. When in doubt call us anytime! – TRY again in 5 minutes if you don’t get a call back!
8. Please let us know if your child will be absent from school right away so we can send a school note excusing absence that very same day
9. If your child continues to miss school or is being sent home repeatedly for because of ketones or blood sugar fluctuations we will need to see you for a f/u appointment earlier than scheduled
10. If your child cannot hold fluids go to the emergency room
How to give fluids?
1. If the child is drinking & NOT eating – provide un-carbonated fluids which have sugar in them, count the carbs & give insulin to cover the carbs. To avoid ketone buildup it is important the child has sugar & insulin.
2. If your child is drinking and eating – give sugar free fluids – sip by sip/tablespoon by tablespoon/teaspoon by teaspoon. Give insulin for carbohydrate containing food.
3. If the child is nauseous – give ice chips or use a straw for drinking water. Try sugar-free popsicles or sugar popsicles if the child is not otherwise eating.
4. Remember: insulin is as important as fluids during sickness
5. If the child is not holding fluids, take the child to the emergency room
6. Anti-vomiting medication (Zofran etc.) are only useful if we know there is no other reason for vomiting – remember appendicitis, UTI, intussusception can all present with vomiting
While Traveling
1. Have a checklist – keep the checklist in multiple places if needed, including the glove compartment of your car, your wallet, and always have the checklist on your phone.
2. Split supplies into two (carry on and checked baggage if flying)
3. Know the 24 hour pharmacy number in the vacation place and save the number
4. Keep a copy of all the insulin doses and pump settings (updated)
5. Travel note from your doctor for air travel
6. CHECK LIST: Back up long acting and short acting insulins, insulin pen, insulin syringes, needles, blood sugar meter, strips, glucagon, glucose gel/cake icing, pump supplies, updated insulin doses and pump setting
Pump or site failures
1. If blood sugars are high and stay high after a site change – site is usually bad
2. Site failures are more common than pump failures
3. Pump has a baseline delivery (basal) and delivery of bolus as needed (bolus)
4. The average total daily basal is your basal insulin (e.g. Lantus, glargine, levemir, basalgar) dose) Give it once a day or divide it into 2 doses and give 12 hours apart. (check the backup insulin for expiry date periodically)
5. Your short acting dose at time of food is the combination of your correction and insulin carb ratio
6. Check blood sugar every 4 hours and give short acting insulin, if not on pump.
7. Call the pump support line to trouble shoot
8. K-I-S-S protocol when blood sugars don’t come down after repeated bolus(K - check for ketones, I - injection of insulin to make sure insulin is going in, S - site change, S- sugar check an hour after doing KISS
Low blood sugars
1. If the child has seizures or unconsciousness, call 911 & give glucagon. No need to check blood sugar
2. If the blood sugar is low without loss of consciousness or seizures then, give glucose gel, cake icing or any sugary drink and follow the 15 minute rule
3. Don’t forget to look for reasons, why the blood sugar is low and it might be time to revisit and decrease the insulin dose.