_________’s

Diabetes ID Sheet
* Include a picture of your child at the top of the document!*
My name is _________. I am 4 years old and wear and insulin pump and continuous
glucose monitor to control my diabetes. I was diagnosed in April, 2009.

With Type 1 Diabetes, my pancreas can no longer make insulin. Without insulin, the food I eat cannot be used for energy.
Each time I eat, I must count the number of carbs I eat and do a calculation to determine the amount of insulin I need.
Insulin is not a cure but life support. Exercise, food, illness and emotions can all affect my blood sugar. It is important
to understand some facts about diabetes while I’m in your care.

Taking Care of Me:

• My blood sugar gets checked around 7-10 times a day. My normal range is 80-180.
• Check my blood sugar:
* before I eat
* before and after strenuous activity (like PE or recess)
* when I have symptoms of high or low blood sugar (see below)
* if I’m not acting like me
* if you have ANY QUESTIONS or CONCERNS that something isn’t right
• I go to the clinic to check my blood sugar. But, I do know how to do it myself/tell you what to do!
• I should have an emergency bag of supplies with me at all times.
* DO NOT FEED ME! I am able to eat with my class but I must ALWAYS check my blood sugar first.
The amount of carbs I ate need to be recorded. This information will need to go to the clinic with me so
that my insulin dose can be calculated.
* I should NEVER go anywhere in the school without an adult to accompany me!
Low Blood Sugar (Hypoglycemia) - BG less than 80
• Symptoms: HUNGRY (this is _____'s #1 low symptom), sleepy, upset stomach, staring off into space,
quieter than normal, emotional (crying for no reason or over something that doesn’t make sense),
sweaty, shaky, unable to concentrate
• Treatment: DO NOT LEAVE ME ALONE!! Take me to the clinic to check my blood sugar. If less than
80, give me 2 packs of Smarties OR a Juice Box (found in the clinic or in my emergency bag in the
classroom). Retest my blood sugar in 15 minutes. If blood sugar is still below 80, retreat with 2 more
packs of Smarties OR another Juice Box. Wait 15 minutes and retest. If blood sugar is still low, please
call my mom or dad.
• Tests or exams should NOT be given after a low blood sugar. Wait until my blood sugar has stabilized.
• If I am unconscious or having a seizure, DO NOT FEED ME – CALL 911 and administer
GLUCAGON injection IMMEDIATELY! Position me on my side.
• Low blood sugar can happen quickly. An everyday situation can turn into an emergency in a matter of
minutes. It is very important to keep an eye on me and make sure that I am acting “normal”.
High Blood Sugar (Hyperglycemia) – BG over 180
• Symptoms: emotional (crying for no reason or over something that doesn’t make sense), irritable,
excessive thirst, frequent need to urinate/accidents, weakness, blurred vision, unable to concentrate (
_____describes this as feeling "slow" and being unable to walk and talk.)
• Treatment: take me to the clinic to check my blood sugar, let me drink water, and go to the bathroom
as needed.
• Send me to the clinic to check for ketones if my blood sugar is over 240 more than twice.

Emergency Phone Numbers: __________ (mom) __________

__________ (dad) __________
__________ (grandparents) __________