Diabetes 101For School Employees

Purpose:

To ensure a safe,therapeutic learningenvironment for thestudent with diabetes.*

*and to comply with state law

Diabetes is a chronicillness caused when thepancreas doesn’t make any orenough insulin. (Type I)

Type II Diabetes Insulin is producedby the pancreas but the body’s cellsresist insulin function.

Causes of Diabetes

•Inherited (genetic)

•Autoimmune (self allergy)

•Environmental (viral/chemical)

You don’t outgrow it!

Diabetes is not contagious!

This is a life-

threatening

health

condition!

Glucose = Sugar

Normal Insulin Function

Food we eat….

…is digested by the stomachand converted to glucose…

…glucose is absorbed by theintestine into the blood.

The pancreas makes insulin and releasesit into the blood stream.

Insulin is the key…

…that “unlocks” the body’scells so glucose can enterthe cells and be burnedfor energy.

Without insulin,the body’s cells can’t burnglucose for energy and sugar accumulates in the blood.

Management of Diabetes

Exercise Insulin

Diet

NormalBlood sugar

Desirable blood sugar for children with diabetes: 70-150mg/dl

Exercise

Too much food…

Diet

Blood sugar

Insulin

…blood sugar rises.

Too much exercise…

Diet

Insulin

Exercise

…blood sugar falls

Blood sugarfalls

Too much insulin…..

Diet

Exercise

Blood sugarfalls

Insulin

…..blood sugar falls.

Insulin

•Hormone

•Taken by multipleinjections throughoutthe day or by a pump

•Lowers blood sugar

•Many different types

Types of Insulin

Rapid acting (Humalog)onset 15 minutespeaks 30-90 minutes

Intermediate (NPH, Lente)onset 1-4 hourspeaks 6-12 hours

duration about 3.5 hrs duration 12-24 hours

Short acting (Regular)onset 30-60 minutespeaks 2-4 hoursduration 4-8 hours

Long Acting (Ultra Lente)onset 4-6 hourspeaks 8-15 hoursduration 18-24 hours

Long Acting (Lantus)given 1x/day

Slower, prolonged absorptionNo peak

Insulin•Additional points

•All insulin lowers blood sugar but peaks (has its maximumeffect) at different times.

•Rapid acting insulin starts to work very quickly and leavesthe body quickly. Meals must be eaten immediately afterinjecting this insulin.

•Short acting is ideally injected 30 minutes before eating.

•Most students are on a “sliding scale” that allows thedosage of rapid-acting or short acting insulin to beadjusted according to blood sugar level and food intake.

Meal Planning

•Student may need 2-3 snacks/day.

•Student may be counting carbohydrateseaten to calculate insulin dosage.

•Sugar is ok and small or calculatedamounts are acceptable in a diabetesmeal plan.

Carbohydrates

Most important aspect of the meal plan

Include bread and starches, and fruit

Main source of blood glucose – approx. 90-100% enters the blood stream as glucose15 min.-2 hours after eating

Proteins

Approx. 50-60% of dietary protein isconverted to glucose and released into theblood stream 2-5 hours after meal

Includes meat, fish, poultry, eggs, peanutbutter, cheese, and meat alternatives

Adds ‘staying power’ to the meal

Fats

Negligible (less than 10%) effect onblood sugar levels.

Delays/slows the digestive process.

The fat in fatty foods, i.e., frenchfries or chocolate, delays theabsorption of the sugar.

Suggestions for Exercise/Sports•Organized sports and other forms of activeplay are a great way for a child to stayphysically fit.

•May need snack before intensive exercising(p.e.).

•Have extra snacks available during exercise.

•School staff supervising the exercise/sportsactivities must follow the emergency action plan.

Blood Sugar Testing

•Research has shown that maintaininggood control of blood sugar levels canprevent long-term complications ofdiabetes

•Testing is often performed 3-4 timesdaily

•Helps determine appropriatetreatment

Procedure1. Student or nurse obtains a drop

of blood which is then placed on atest strip.

2. Strip is placed in monitor and itgives a digital readout of currentblood sugar level.

BLOODBORNEPATHOGENPRECAUTIONS AREREQUIRED!

Diabetic Equipment andSupplies Provided by ParentMay Include:•Blood sugar testing kit

•Insulin and injection supplies

•Snacks

•Quick sugar sources

•Ketone testing supplies

FIELD TRIP REMINDERS•Take the Emergency Action Plan

•Take emergency supplies (snack, quick sugarsource, blood testing equipment, etc)

•Plan ahead, determine how to contactemergency services, to and from location.

•Take cell phone but confirm coverage areafor trip

•Trained district staff or parent must beavailable to assist student.

Low Blood Sugar(Hypoglycemia)

•Is generally defined as blood sugarless than 60mg/dl (see student’s IHP).

•A low blood sugar episode does notfeel good and it may be frightening tothe student.

•Student may feel “low” and show anyof the following symptoms:

Hypoglycemia

(Low blood sugar,insulin reaction)

* *Symptoms

*

*caused by release of adrenalin

Additional symptoms

•Pale skin color

•Inability to concentrate

•Personality change

Causes of Low Blood Sugar

•Late or too little food

•Too much exercise

•Too much insulin

Treatment of Mild Low Blood Sugar

Follow student’s emergency action plan. Student treatsself by ingesting quick sugar source such as:

Glucose tablets

Juice 4-8 oz.

Regular soda (non diet): 1/2 can

4 or 5 pieces ofhard candy

Follow-up Treatment of Mild Hypoglycemia

•Wait 10-15 minutes and retest.

•If blood sugar remains <60 or if symptomspersist repeat quick sugar source.

•Follow with snack of complexcarbohydrates and proteins (cheese andcrackers) if next meal is > ½ hr away.

If blood sugar continues to fallyou may see:

•Behavior changes•Poor coordination•Complaint of headache•Confusion•Blurry vision•Weakness•Slurred speech

*treat the same as mild blood sugar

Severe Low Blood Sugar

Seizure

Loss of Consciousness

Call 911

Treatment ofSevere Low Blood Sugar

•Follow the student’s emergency actionplan.

•Call 911.

•Position on side if possible.

•Don’t attempt to give anything bymouth.

EMERGENCY ALERT

Low blood sugar can developwithin minutes and requiresimmediate attention.

Never send a student withsuspected “low blood sugar”anywhere alone.

School Bus Considerations•NEVER put a student with low blood sugaron the bus.

•Contact parent if a low blood sugar episodeoccurs within 30 minutes prior to departure(includes students walking home).

•Students having signs of low blood sugarand able to swallow should be allowed to eata snack on the bus.

If You Have a Way to CheckBlood Sugar, Do So.*BUT ALWAYS, WHEN INDOUBT, TREAT WITH QUICK-ACTING SUGAR SOURCE

High Blood SugarHyperglycemia

• Blood sugar greater than 240 mg/dl.

•Occurs over time (hours to days).

•Students not yet diagnosed may exhibitsome or all of the symptoms, includingweight loss.

•Student may feel high and show any ofthe following symptoms:

Hyperglycemia

(high blood sugar)

Symptoms

Treatment of Hyperglycemia

•Follow emergency action plan

•Drink zero-calorie fluids, (i.e., wateror diet soda)

•Check ketones, if test strips available(many students will not test forketones at school)

•Decrease activity if ketones arepresent

Severe Hyperglycemia•Very weak

•Confused

•Labored breathing

•Unconscious

•Coma

•Call 911

Treatment ofSevere High Blood Sugar

•Follow the student’s emergency actionplan.

•Call 911.

•Position on side if possible.

•Don’t attempt to give anything bymouth.

Long Term Effects of Hyperglycemia

•Vision problems blindness

•Nervous system problems

•Kidney failure dialysis

heart•Vascular changesdisease, amputations

The Law and Diabetes•Diabetes is considered a disability underfederal law (504).

•All students with diabetes must have ahealth care plan in place.

Children with diabetes must have full

access to all activities, services, or benefitsprovided by public schools.

Individual Health Care Plans/HCP Orders

•Health Care Plans are individualized for eachstudent.

•Each student will have an emergency action plan thatspecifies what to look for and what to do in anemergency.

•Prior to school entry, orders should have beenreceived from the child’s health care provider (HCP).

•Check with your school nurse or office personnel forlocation of health care plans.

•

What is unlicensed diabetes care assistant (UDCA)?

The principal must identify school employees (other than health care professionals) to serve as unlicensed diabetes care assistants, who will be trained to assist with daily or emergency care of students with diabetes if/when a school nurse is not available.

What is unlicensed diabetes care assistant (cont.)

The principal must ensure that the school has at

least one unlicensed assistant if the school has a

full-time nurse; if there is no full-time nurse, the

school must have at least three unlicensed

assistants. A school employee may not be subject

to any penalty or disciplinary action for refusing to

serve as an unlicensed diabetes care assistant.

Suggested Accommodations

•Location for blood sugar monitoringand/or insulin injection will be determinedby the School Nurse, parents, andstudent.

•Allow blood glucose monitoring as needed.

•Student may also need to check sugar onfield trips or during special events.

•Allow student to snack when and wherenecessary to maintain adequate bloodsugar levels.

•Parents are responsible to supply snacksfor school.

•At least one snack should be readilyavailable for emergency consumption.

•If no response to the snack and/orsymptoms worsen, accompany student toNurse’s office or call for help in classroom.

•Allow water to be consumed as needed.

•Allow bathroom privileges as needed.

•Exercise is essential.

•Parent may provide a “disaster kit” for theirchild which includes extra diabetic supplies inthe event of an extended emergency at school.

•Parents should be given at least a one-daynotice of extra events such as parties or ‘fielddays.’

•When the student experiences eithera high blood sugar reaction or a lowblood sugar reaction, his/her thoughtprocesses are likely to be adverselyaffected.

•Accommodations will need to be madewith regards to performanceexpectations during the timeimmediately before and for at leastone hour after the episode is treated.

Special Considerations

•Don’t assume that the studentwants/doesn’t want others to know ofhis/her diagnosis.

•Seek help when in doubt.

•NEVER SEND A STUDENT WITHSUSPECTED LOW BLOOD SUGARTO THE NURSES’S OFFICE ALONE.

Common Parent Concerns•Monitoring the health of the childduring the school day.

•‘Labeling’ the student only throughhis/her disease.

•Impact of diabetes on child’seducational performance.

•Why can’t any school staff do the thingsthe parents do routinely at home?

•Can my child go to his/her neighborhoodschool?

YOUR SCHOOL NURSE CAN HELP ADDRESS THESE CONCERNS

Resources

•Contact your school nurse with any questionsor concerns.