children with DIABETES - Glucagon in School Survey

The purpose of this survey is to learn about the experiences that kids have at school if they have ever needed glucagon because of a severe low blood sugar or insulin because of a high blood sugar. All responses are confidential, and you do not have to include your contact information. You may if you like.

1. In what grades are your children with diabetes?
2. Does your child's school allow glucagon to be stored on site for emergency use?

Yes
No
I don't know

3. Who at your child's school is permitted to administer glucagon?

School nurse only
School nurse and trained teachers or other trained school staff members
School staff members who have not received training
No one is permitted to administer glucagon
School calls 911
I don't know
Other (please specify)

4. If your child has glucagon at school, has it ever been needed? That is, has your child ever experienced a severe low that required intervention?

Yes
No
I don't know

5. If your child has had a low that required glucagon, was it actually used?

Yes
No
I don't know

6. If your child had glucagon injected at school, what was the outcome?

My child recovered quickly from the low and remained at school
My child recovered and was taken home
My child recovered and was taken to a hospital
Other (please specify)

7. If your child required glucagon but it was not injected, what was the outcome?

My child recovered at school without additional help
A parent went to school and my child recovered at school
Emergency medical help was called and my child recovered at school
Emergency medical help was called and my child recovered at the hospital
My child experienced serious injury or impairment (please explain below)
Other (please specify)

8. If your child experienced a serious injury or impairment because glucagon was not injected, please explain.

9. Does your child need to inject or bolus insulin while at school?

Yes
No

10. Under what circumstances does your child inject or bolus insulin while at school? Check all that apply.

Routine insulin to cover carbohydrates eaten during meals
Supplemental insulin to cover treats (e.g., birthday parties)
Supplemental insulin to correct a high blood sugar
Other (please explain)

11. Who at your child's school is permitted to administer insulin? Check all that apply.

Child self-administers
School nurse
Nurses aid (not a nurse, but in the clinic)
Trained teachers or other school staff members
Parent required to come to school to administer insulin
No one administers insulin
Other (please specify)
I don't know

12. If your child has needed insulin at school and it was not administered, what was the outcome? Check all that apply.

My child had high blood sugar levels that should have been treated with insulin
My child had high blood sugar levels that led to DKA
My child had high blood sugar levels that required subsequent absence from school
My child had high blood sugar levels that required an emergency room visit or hospitalization
Other (Please explain)

13. If you would like to add any details or personal experiences related to this survey, please do so here.

14. If you would like to include your contact information, please do so here. It is not required.

Name
Address
City
State
Other State
ZIP/Postal Code
Country
Telephone
Email



		Glucagon in School Survey

		Not Helpful 1 2 3 4 5 Very Helpful E-mail Page Print Format