diabetes 101 for school employees. purpose: to ensure a safe, therapeutic learning environment for...
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Diabetes 101For School Employees
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Purpose:
To ensure a safe,therapeutic learningenvironment for thestudent with diabetes.*
*and to comply with state law
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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.
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Causes of Diabetes
•Inherited (genetic)
•Autoimmune (self allergy)
•Environmental (viral/chemical)
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You don’t outgrow it!
Diabetes is not contagious!
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This is a life-
threatening
health
condition!
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Glucose = Sugar
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Normal Insulin Function
Food we eat….
…is digested by the stomachand converted to glucose…
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…glucose is absorbed by theintestine into the blood.
The pancreas makes insulin and releasesit into the blood stream.
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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.
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Management of Diabetes
Exercise Insulin
Diet
NormalBlood sugar
Desirable blood sugar for children with diabetes: 70-150mg/dl
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Exercise
Too much food…
Diet
Blood sugar
Insulin
…blood sugar rises.
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Too much exercise…
Diet
Insulin
Exercise
…blood sugar falls
Blood sugarfalls
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Too much insulin…..
Diet
Exercise
Blood sugarfalls
Insulin
…..blood sugar falls.
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Insulin
•Hormone
•Taken by multipleinjections throughoutthe day or by a pump
•Lowers blood sugar
•Many different types
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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
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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.
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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.
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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
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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
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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.
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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.
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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
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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!
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Diabetic Equipment andSupplies Provided by ParentMay Include:•Blood sugar testing kit
•Insulin and injection supplies
•Snacks
•Quick sugar sources
•Ketone testing supplies
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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.
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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:
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Hypoglycemia
(Low blood sugar,insulin reaction)
* *Symptoms
*
*caused by release of adrenalin
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Additional symptoms
•Pale skin color
•Inability to concentrate
•Personality change
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Causes of Low Blood Sugar
•Late or too little food
•Too much exercise
•Too much insulin
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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
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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.
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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
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Severe Low Blood Sugar
Seizure
Loss of Consciousness
Call 911
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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.
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EMERGENCY ALERT
Low blood sugar can developwithin minutes and requiresimmediate attention.
Never send a student withsuspected “low blood sugar”anywhere alone.
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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.
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If You Have a Way to CheckBlood Sugar, Do So.*BUT ALWAYS, WHEN INDOUBT, TREAT WITH QUICK-ACTING SUGAR SOURCE
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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:
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Hyperglycemia
(high blood sugar)
Symptoms
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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
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Severe Hyperglycemia•Very weak
•Confused
•Labored breathing
•Unconscious
•Coma
•Call 911
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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.
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Long Term Effects of Hyperglycemia
•Vision problems blindness
•Nervous system problems
•Kidney failure dialysis
heart•Vascular changesdisease, amputations
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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.
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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.
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•
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.
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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.
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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.
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•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.
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•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.’
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•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.
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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.
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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
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Resources
•Contact your school nurse with any questionsor concerns.