1 / 1

DIABETES MEDICAL MANAGEMENT PLAN FOR SCHOOL

Community School District #128 Health Services Libertyville High School Vernon Hills High School. 847-327-7016. 847-932-2040. DIABETES MEDICAL MANAGEMENT PLAN FOR SCHOOL. Student: ______________________________ DOB: __________________________________

charo
Download Presentation

DIABETES MEDICAL MANAGEMENT PLAN FOR SCHOOL

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Community School District #128 Health Services Libertyville High School Vernon Hills High School 847-327-7016 847-932-2040 DIABETES MEDICAL MANAGEMENT PLAN FOR SCHOOL Student: ______________________________ DOB: __________________________________ Student ID#: ___________________________ School: ________________________________ Type of Diabetes: Type 1 Type 2 Pre-Diabetes Date of Diagnosis: _____________ Other: ____________________________________________________________ Blood Glucose Monitoring Meter type: Blood glucose target range: ______-______ mg/dl Blood glucose testing times: ________________________________________ For suspected hypoglycemia At student’s discretion excluding suspected hypoglycemia Only at student’s discretion No blood glucose testing at school Permission to test independently Supervision of testing/results Student will need assistance with testing and blood glucose management.: Test blood glucose 10 to 20 minutes before boarding bus. Diabetes Medication No insulin at school: Current insulin at home ___________________________________________________ Oral diabetes medication at school: __________________________________________________________ Insulin at school: Humalog Novolog Lantus Other: ________________________ Insulin delivery device: Syringe and vial Insulin pen Insulin pump Standard lunchtime dose: _________________________________________________________________ Insulin dose for school:____________________________________________________________________ Meal bolus: _______ units of insulin per ________ grams of carbohydrate. Correction for blood glucose: ______ units of insulin for every ______ md/dl above _______ mg/dl. (Correction bolus can be given with meals or every 3 hours if blood glucose levels are high) Blood Glucose Value (mg/dl) Units of Insulin Less than 100 100-150 151-200 201-250 251-300 301-350 352-400 More than 400 Note: Insulin dose is a total of meal bolus and correction bolus. Parent may adjust insulin doses as needed. Student may self manage.

More Related