If licensed nurse is present, give Glucagon if blood sugar is low as ordered per If student is not breathing and/or has no pulse, initiate CPR until help arrives. …
DIABETES
Emergency Action Plan
Student Name: _________________________ DOB: ____________________
Grade/Teachers: ________________________
Parent/Guardian: ________________________ Emergency s: ____________
________________________
____________
Other Relative: ________________________ Emergency s: ____________
Physician: _____________________________ Office : _________________
School Nurse: __________________________
Current Medications: ______________________________________________
Drug Allergies: __________________________________________________
For loss of consciousness, seizure disorientation, combativeness, inability
or refusal to take food or juice:
THIS IS AN EMERGENCY
Call 911 and parents
If licensed nurse is present, give Glucagon if blood sugar is low as
ordered per MD
Check the student for breathing and pulse If student is not
breathing and/or has no pulse, initiate CPR until help arrives
Turn the student on their side in case vomiting occurs
Perform blood sugar check to determine if blood sugar in high or low
If student is alert and blood sugar is low, apply glucose gel or cake
icing
between the cheek and gum Massage the outside of the cheek
with head elevated
Check blood sugar in 5 minutes
After 5-10 minutes, if the student is alert enough to cooperate and
swallow, give cup regular-not sugar free- soda or juice and a snack
of peanut butter or cheese crackers
Recheck blood sugar after 15-20 minutes
__________________________ _______________________________
Physicians Signature/Date Parent Signature/Date
