Considerations for the Management of Hypoglycemia and Diabetes in Schools - Episode 5
An expert in diabetes education provides an overview of dosing requirements and appropriate administration requirements necessary for the administration of hypoglycemia rescue therapies.
Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES: School staff, school nurses, and anyone that's involved with the student during the school day should be trained on how to use glucagon on an annual basis. Those are training recommendations from the Safe School Improvement Acts throughout the states. Now, what is going to be the best method of treatment? I'm a hands-on kind of girl. So again, making sure that even demonstration options are available for the staff to be able to just play around with is great, but there are plenty of videos as well as print materials that can be read to get that kind of training. However, when we think of glucagon, it is something that is a little more fearful in the minds of staff. Making sure that they're a little more comfortable with using it but also understanding how easy some of the newer methods are to use so that they don't have to really worry so much when they're actually delivering it is important.
One other thing about the glucagon types that are available: if using the traditional glucagon emergency kit, that’s going to have to be reconstituted. Children who are under 12 and under 100 pounds are going to require about half the typical dose. The prefilled injectables are available in either the half amounts or the full amount. So again, if you have a child that's over 100 pounds, they're going to need the full amount like an adult. So making sure that those are definitely delineated. And then the nasal is one of those that has the same amount regardless of the weight of the child. But again, definitely making sure that for that student with diabetes, that you have the correct formulation for their weight.
When I think of some of the challenges that are inherent with using glucagon itself, in the past, it was really because the only version that we had available was really hard to use. That alone has deterred a lot of people from actually using it or even getting prescriptions for it. So now that we're having newer formulations that have much simpler ways to deliver, we're going to be seeing that some of those challenges go away. Still, the challenge does include the prescription itself. We do know the number of people who are on insulin; it's nowhere near 100% of those that are getting glucagon. So we know that we need to increase the prescriptions. So again, those glucose—those rescue medications are available—and be sure that the child does have multiples throughout the school. Again, have one in the nurses' station or the front office, one in the classroom, one in their backpack just in case, or their emergency go-bag. We want to make sure that by making sure that they have multiples, and having easier modalities, that we're going to be minimizing those challenges. As I mentioned, the challenge still is whether the family can afford having this rescue medication itself. And so making sure that they're talking with their health care provider or finding methods to make sure that they're getting the most affordable cost, because this is one of the most important rescue medications that we can have for children with diabetes.
Transcript edited for clarity