Notes for the Babysitter / Daycare Personnel

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_________________________ has diabetes. This is a chronic condition in which the pancreas does not produce insulin or does not use insulin efficiently. Without insulin, the body cannot use food for energy. Children with diabetes must take multiple insulin injections, monitor blood sugars and follow a specific meal plan.

Please follow these instructions:

Test blood sugar at ________________ o'clock. Result: _______________

Give insulin injection at ____________ o'clock. Dose: ________________

Meals or snacks:

Give ________________________________ at _________o'clock

Give ________________________________ at _________o'clock

Give ________________________________ at _________o'clock

An insulin reaction may occur if the blood sugar goes too low.

Some common signs of insulin reactions are:

• Dizzy
• Weak
• Tired
• Behavior changes
• Hungry
• Confusion
• Shaky

_________________ usually shows the following symptoms when having a low blood sugar:____________________________________________________

If this occurs, immediately check a blood sugar.

If the blood sugar is less than ____________give: ______________________________________________________then recheck blood sugar in 15 minutes.

Repeat the above until the blood sugar is above __________then give: ___________________________________________if there is more than an hour until the next scheduled meal or snack.

Additional instructions:__________________________________________________________

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Parents can be reached at: ________________________________________

Doctor's name: ______________________ Phone ___________________

If an Emergency (Moderate/large ketones, loss of consciousness, seizure) after 5pm, before 8 am, holidays and weekends, call
(317) 274-5000 and ask for the Pediatric Diabetes Doctor on call.