Advice Packet

Low blood sugar in school:

  • Keep fast acting carbs in your backpack

  • Carry a glucagon kit in case of emergencies and make your family aware of which school staff are trained to administer it

  • Make sure the school nurse or a trusted teacher also has fast acting carbs in case you have none on you


Low blood sugar in public (other than school):

  • Keep fast acting carbs on someone when you are out in public

  • Carry a glucagon kit in case of emergencies

  • Make sure there is an access to fast acting carbs near you if you are not carrying any


High levels of exercise:

  • Consider taking off insulin pump if you have one before exercising (but have a way to remind yourself to put it back on/resume delivery after exercise)

  • Be more conservative with insulin before exercising

  • Keep fast acting carbs nearby if blood sugar starts to drop, stop exercising to take care of blood sugar before returning to activity

  • Be extra aware of the possibility of low blood sugars for up to 24 hours after higher levels of exercise


Super hot days:

  • Be more conservative with insulin depending on how your body reacts with heat and humidity

  • Have extra fast acting carbs on hand when out in the heat


Pump site comes off:

  • Have a plan for getting a new site and be able to replace it in a clean environment

  • If in school, leave an extra set of supplies in the nurse's office or a trusted teacher’s room

  • Try and keep an extra set of supplies in the car if needed (not insulin)

  • Call a professional depending on the severity of the situation or if you need some extra assistance


No insulin pump/other supplies:

  • Try to figure how to get to the needed supplies in the safest and most efficient way

  • Keep insulin out of environments that can have varying and/or extreme temperatures such as a car

  • Call your health care provider if you do not know what to do


Signs of a high blood sugar:

  • Increased thirst/urination

  • Fatigue

  • Feeling off/blurred vision

  • Irritability

  • Trouble concentrating

  • If blood sugar remains high, check for ketones with urine stick or blood monitor

  • High blood sugars can be harder to detect and can sometimes be mistaken for a low blood sugar, so check your blood sugar level to be sure

  • For closed loop pump system users: be careful of bolusing because the pump may already be trying to correct the high blood sugar

  • For traditional pump system users/injections users: follow your health care providers guidelines for treating high blood sugars


Signs of a low blood sugar:

  • Shakiness

  • Increased hunger

  • Sweating

  • Clouded judgment/thinking

  • Dizziness and confusion

  • Low blood sugars may have more warning signs and cause more immediate danger

  • Low blood sugars can be corrected with fast acting carbs (15:15 rule, have 15 grams of carbs and check blood sugar again in 15 minutes)

  • It can help to eat an extra snack with protein, fat, and fast acting carbs to help stabilize your sugars

  • Try out different fast acting carbs, some might work better for you than others

  • Keep glucagon on hand at all times in case of emergency


Clothing and insulin pumps:

  • Can use a clip to clip it to pants or bra, also fanny-pack type pouch is an option

  • Tip: try turning the pump face towards your body and clip on the inside of your clothing because it can stay more securely

  • Clipping it to the back on your clothes can help hide it and not take away from your outfit

  • Omnipod is an alternative if you do not want tubing connecting you to your  insulin pump

  • If you are wearing a dress it can be clipped to your underwear or spandex

  • Wear something that can identify you as having diabetes, some medical facilities have some or can buy personalized items or rubber bracelets online


Carrying supplies:

  • Small bags are good to keep on hand in public with necessary supplies

  • Backpacks are also sufficient if you choose to carry supplies on your own in school

  • Alcohol wipes are usually not thought about but are great to have to use for multiple diabetes related issues


Different places to put pumps/pods/CGMs on the body:

  • Upper arm: great for a CGM or pod, using the back of the arm can hide it relatively well, pump site can be clipped on a bra or pants with a long enough tubing, good place for physical activity

  • Back: least amount of fat most likely, can rub against pants line, hard to self apply, hide easily with clothing

  • Upper stomach: good for any device, can become irritated when on your stomach, hide easily with clothing

  • Lower stomach: good for any device, can rub against pants line

  • Thigh: good for pump sites, more noticeable, good for physical activity

  • Different areas are better for certain people and can depend on your daily living

  • Make sure your healthcare provider is aware of where you are inserting the catheter.


Little kids:

  • Kids generally do not understand how diabetes works or why you have things such as an insulin pump (telling them your pump is for medicine because your body does not work properly usually does the trick for kids who keep asking)

  • Be patient with little kids, they can be easily distracted and are only being curious and not hurtful 

  • Find ways to be upfront with classmates (especially younger children) to help kids and teachers understand what is going on with their friend


Metal detectors with insulin pumps:

  • Be communicative and tell workers about your diabetes and that you can not go through

  • Understand that some workers do not understand or are going through the motions to get people through and can come off in the wrong way

  • Be communicative with what you are comfortable with, ask for a pat down in private if you are not comfortable doing it in front of others

  • Be aware that some detectors are insulin pump friendly


Contacting your provider:

  • It is always best to have your providers number on hand

  • Leave the number somewhere easily accessible like the fridge or in your phone contacts

  • If the number is not working, your primary care physician can be of assistance but they are not endocrinologists


Vacations:

  • Ensure to have enough supplies and insulin for the duration of the trip

  • Having an extra set of everything is always smart in case there are any issues

  • Bring extra needles or pen in case pump stops working for pump users

  • Be aware of any weather adjustments that may affect your blood sugars such as hot, humid weather (may want to talk to provider beforehand)

  • Make yourself aware of nearby medical facilities in case of emergency


Eating and insulin:

  • Not all carbs are created equal, some foods affect you differently and can spike your blood sugar (common foods are ones in a large amount of oil such as pizza and Chinese and other simple carbs such as pasta, breads, cake and sugary drinks)

  • Simple carbs are digested a lot faster than complex carbs and tend to spike your blood sugar more

  • Technology has made it easy to eat what you want, think of it as what you can eat and not what you can’t

  • Other things that can affect eating habits are things like other autoimmune diseases, religious reasons, and other lifestyle of eating and can affect your health and effects on body

  • Insulin is a medicine and does not respond to people in the same ways, may take some time to find the right insulin and dosages

  • Be aware that blood sugars may be affected later in the day due to eating or even prolonged high heat exposure


Insulin pump vs injections/insulin pen:

  • Insulin pump: more direct and exact insulin boluses, automatic calculations when bolusing, less needle sticks, multiple devices could be attached to body, still need another form of injections if pump stops working

  • Injections/insulin pen: more rounded insulin boluses, need to do calculations for injections, more frequent needle sticks, nothing adhered to body unless using CGM


Information to provide adults (teachers, counselors, etc)

  • Be open about specific issues on diabetes that are related to you

  • Be straightforward about your personal diabetes strengths and weaknesses

  • Simple is better, providing the information that they need to know makes it easier to remember

  • Information such as having diabetes, how well managed you are, what you do for highs and lows, and what type of supplies you use is about all the information they need

  • Do not feel obligated to share past your comfort level

  • Know that when people are curious, they are usually trying to understand your health better

  • Consider creating a half sheet of paper with all information as well to give to adults and substitute teachers

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