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[CHILD’S NAME]

Type 1 Diabetes

DOB: ***
[INSURANCE] MR#: ***
T1D Medical Team: ***

Parent/Caregiver 1: (***) ***-****
Parent/Caregiver 2: (***) ***-****
ABOUT ME I live at home with ***.  I love ***, ***, and ***. I am insulin-dependent. My body cannot control on its own how high or low my blood glucose (BG) goes.

Insulin lowers my BG when HIGH & helps me stay IN RANGE when eating

Food/Sugar raises my BG when LOW.

1. Both High and Low blood sugar are dangerous for me. Both require action ASAP. Low blood sugar can become an immediate medical emergency.
2. I wear a Continuous Glucose Monitor (CGM) called a [NAME CGM] on my body - this measures my BG every 5 minutes. This connects to my phone. My phone needs to be with me at all times. You can check my blood sugar on my phone (unlock code ***), there is a *** app (COLOR?) on my Home Screen.
3. When you hear a BEEP — please check my phone to see my number and what direction the arrow is going. NEVER mute my phone.
4. I feel my best when my blood sugar is between 70-180. TRUST ME when I say I am low.  We may need to check the accuracy of my Dexcom with a finger check on my blood glucometer.
5. My [INSULIN DEVICE] is a device on my body that administers Insulin.  I need insulin any time I eat or have High blood sugar that needs a correction. Use the blue Bolus button to enter my BG (use sensor) and amount of carbs.
6. With a lot of activity, my blood sugar risks going Low. Please set my device in Activity Mode just before & for the duration of moderate to high activity.

[CGM] ARROWS

WHEN & HOW TO ACT

• 70-80 steady/80-100 slow down — ~10g protein-based carb snack, recheck 15 min
• Straight arrows down or Below 70 — fast-acting carb snack (sugar!) 10-15g, recheck 15 min
• No CGM Reading — check BG by glucometer & monitor for low/high BG.  
• Steady Rise 2 hours after last insulin OR Above 250 — give insulin correction & hydrate with water.

EMERGENCY If I am unconscious or having a seizure I need help immediately. BAQSIMI — emergency nasal spray that rapidly raises my blood glucose. It is in a yellow/white tube in my supplies. Pull red tab, insert tip into one nostril & press device plunger until the green line is no longer showing. Call 911.  Once conscious, give juice & snack.