Diabetes 101

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Diabetes 101 For School Employees
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Purpose To ensure a safe, therapeutic learning
environment for the student with diabetes.
and to comply with state law
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Diabetes is a chronic illness caused when the
pancreas doesnt make any or enough insulin.
(Type I)
Type II Diabetes Insulin is produced by the
pancreas but the bodys cells resist insulin
function.
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• Causes of Diabetes
• Inherited (genetic)
• Autoimmune (self allergy)
• Environmental (viral/chemical)

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You dont 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 stomach and converted to
glucose
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glucose is absorbed by the intestine into the
blood.
The pancreas makes insulin and releases it into
the blood stream.
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Insulin is the key
that unlocks the bodys cells so glucose can
enter the cells and be burned for energy.
Without insulin,the bodys cells cant
burn glucose for energy and sugar accumulates in
the blood.
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Management of Diabetes
Diet
Normal Blood sugar
Insulin
Exercise
Desirable blood sugar for children with diabetes
70-150mg/dl
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Too much food
Diet
Blood sugar
Exercise
Insulin
blood sugar rises.
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Too much exercise
Diet
Blood sugar falls
Insulin
Exercise
blood sugar falls
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Too much insulin..
Diet
Blood sugar falls
Exercise
Insulin
..blood sugar falls.
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• Insulin
• Hormone
• Taken by multiple
• injections throughout
• the day or by a pump
• Lowers blood sugar
• Many different types

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Types of Insulin Rapid acting (Humalog)
Intermediate (NPH, Lente) onset 15
minutes onset 1-4 hours peaks 30-90
minutes peaks 6-12 hours duration about 3.5 hrs
duration 12-24 hours Short acting
(Regular) Long Acting (Ultra Lente) onset 30-60
minutes onset 4-6 hours peaks 2-4 hours peaks
8-15 hours duration 4-8 hours duration 18-24
hours Long Acting (Lantus) given
1x/day Slower, prolonged absorption No peak
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• Insulin
• Additional points
• All insulin lowers blood sugar but peaks (has its
  maximum effect) at different times.
• Rapid acting insulin starts to work very quickly
  and leaves the body quickly. Meals must be eaten
  immediately after injecting this insulin.
• Short acting is ideally injected 30 minutes
  before eating.
• Most students are on a sliding scale that
  allows the dosage of rapid-acting or short acting
  insulin to be adjusted 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 carbohydrates eaten to
  calculate insulin dosage.
• Sugar is ok and small or calculated amounts are
  acceptable in a diabetes meal 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 glucose 15 min.-2
  hours after eating

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Proteins

• Approx. 50-60 of dietary protein is converted to
  glucose and released into the blood stream 2-5
  hours after meal
• Includes meat, fish, poultry, eggs, peanut
  butter, cheese, and meat alternatives
• Adds staying power to the meal

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Fats

• Negligible (less than 10) effect on blood sugar
  levels.
• Delays/slows the digestive process.
• The fat in fatty foods, i.e., french fries or
  chocolate, delays the absorption of the sugar.

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• Suggestions for Exercise/Sports
• Organized sports and other forms of active play
  are a great way for a child to stay physically
  fit.
• May need snack before intensive exercising
  (p.e.).
• Have extra snacks available during exercise.
• School staff supervising the exercise/sports
  activities must follow the emergency action plan.

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• Blood Sugar Testing
• Research has shown that maintaining good control
  of blood sugar levels can prevent long-term
  complications of diabetes
• Testing is often performed 3-4 times daily
• Helps determine appropriate treatment

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• Procedure
• Student or nurse obtains a drop of blood which is
  then placed on a test strip.
• 2. Strip is placed in monitor and it gives a
  digital readout of current blood sugar level.

BLOODBORNE PATHOGEN PRECAUTIONS ARE REQUIRED!
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• Diabetic Equipment and Supplies Provided by
  Parent May 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 sugar
  source, blood testing equipment, etc)
• Plan ahead, determine how to contact emergency
  services, to and from location.
• Take cell phone but confirm coverage area for
  trip
• Trained district staff or parent must be
  available to assist student.

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• Low Blood Sugar
• (Hypoglycemia)
• Is generally defined as blood sugar less than
  60mg/dl (see students IHP).
• A low blood sugar episode does not feel good and
  it may be frightening to the student.
• Student may feel low and show any of 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
students emergency action plan. Student treats
self by ingesting quick sugar source such
as Glucose tablets Juice 4-8
oz. Regular soda (non diet) 1/2
can 4 or 5 pieces of hard candy
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• Follow-up Treatment of Mild Hypoglycemia
• Wait 10-15 minutes and retest.
• If blood sugar remains lt60 or if symptoms persist
  repeat quick sugar source.
• Follow with snack of complex carbohydrates and
  proteins (cheese and crackers) if next meal is gt
  ½ hr away.

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• If blood sugar continues to fall
• you 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 of Severe Low Blood Sugar

• Follow the students emergency action plan.
• Call 911.
• Position on side if possible.
• Dont attempt to give anything by mouth.

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EMERGENCY ALERT Low blood sugar can develop
within minutes and requires immediate
attention. Never send a student with suspected
low blood sugar anywhere alone.
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• School Bus Considerations
• NEVER put a student with low blood sugar on the
  bus.
• Contact parent if a low blood sugar episode
  occurs within 30 minutes prior to departure
  (includes students walking home).
• Students having signs of low blood sugar and able
  to swallow should be allowed to eat a snack on
  the bus.

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If You Have a Way to Check Blood Sugar, Do
So. BUT ALWAYS, WHEN IN DOUBT, TREAT WITH
QUICK-ACTING SUGAR SOURCE
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• High Blood Sugar
• Hyperglycemia
• Blood sugar greater than 240 mg/dl.
• Occurs over time (hours to days).
• Students not yet diagnosed may exhibit some or
  all of the symptoms, including weight loss.
• Student may feel high and show any of the
  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., water or diet
  soda)
• Check ketones, if test strips available (many
  students will not test for ketones at school)
• Decrease activity if ketones are present

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• Severe Hyperglycemia
• Very weak
• Confused
• Labored breathing
• Unconscious
• Coma
• Call 911

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Treatment of Severe High Blood Sugar

• Follow the students emergency action plan.
• Call 911.
• Position on side if possible.
• Dont attempt to give anything by mouth.

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• Long Term Effects of Hyperglycemia
• Vision problems blindness
• Nervous system problems
• Kidney failure dialysis
• Vascular changes heart disease,
  amputations

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• The Law and Diabetes
• Diabetes is considered a disability under federal
  law (504).
• All students with diabetes must have a health
  care plan in place.
• School staff training is mandated by state law.
• Children with diabetes must have full access to
  all activities, services, or benefits provided by
  public schools.

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• Individual Health Care Plans/ HCP Orders
• Health Care Plans are individualized for each
  student.
• Each student will have an emergency action plan
  that specifies what to look for and what to do in
  an emergency.
• Prior to school entry, orders should have been
  received from the childs health care provider
  (HCP).
• Check with your school nurse or office personnel
  for location of health care plans.

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• Parent-Designated Adult
• The law provides for parent to choose an
  unrelated adult to provide blood sugar testing
  and/or insulin administration.
• School district employees are not required to
  serve as the PDA but may volunteer to do so.
• The PDA must sign a letter of intent stating that
  they are volunteering for the position.

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• PDA (cont.)
• PDAs must complete equivalent training to that
  provided by the school district for all employees
  who work with the diabetic student.
• PDAs must also complete special training for the
  additional care they are providing.
• This additional training will not be provided by
  the school district.

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• Suggested Accommodations
• Location for blood sugar monitoring and/or
  insulin injection will be determined by the
  School Nurse, parents, and student.
• Allow blood glucose monitoring as needed.
• Student may also need to check sugar on field
  trips or during special events.

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• Allow student to snack when and where necessary
  to maintain adequate blood sugar levels.
• Parents are responsible to supply snacks for
  school.
• At least one snack should be readily available
  for emergency consumption.
• If no response to the snack and/or symptoms
  worsen, accompany student to health room 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 their
  child which includes extra diabetic supplies in
  the event of an extended emergency at school.
• Parents should be given at least a one-day notice
  of extra events such as parties or field days.

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• When the student experiences either a high blood
  sugar reaction or a low blood sugar reaction,
  his/her thought processes are likely to be
  adversely affected.
• Accommodations will need to be made with regards
  to performance expectations during the time
  immediately before and for at least one hour
  after the episode is treated.

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• Special Considerations
• Dont assume that the student wants/doesnt want
  others to know of his/her diagnosis.
• Seek help when in doubt.
• NEVER SEND A STUDENT WITH SUSPECTED LOW BLOOD
  SUGAR TO THE OFFICE ALONE.

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• Common Parent Concerns
• Monitoring the health of the child during the
  school day.
• Labeling the student only through his/her
  disease.
• Impact of diabetes on childs educational
  performance.
• Why cant any school staff do the things the
  parents do routinely at home?
• Can my child go to his/her neighborhood school?
• YOUR SCHOOL NURSE CAN HELP ADDRESS THESE CONCERNS

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• Resources
• Contact your school nurse with any questions or
  concerns.
• Guidelines for Care of Students With Diabetes,
  can be found at http//www.k12.wa.us/publications
  .
• Video Taking Diabetes To School (contact your
  school nurse).