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Diabetes Training for School Employees


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Title: Diabetes Training for School Employees

Diabetes Training for School Employees
  • Albemarle County Public Schools

Purpose of this Presentation
  • The purpose of this presentation is to provide
    information for use in the training of school
    personnel in the management of diabetes including
    the administration of insulin and glucagon as
    required by the Code of Virginia.

Diabetes in Schools Legislation
  • Virginia Senate Bill 889 requires public schools
    with at least one student diagnosed with diabetes
    to ensure that at least two employees have been
    trained in the administration of insulin and
    glucagon. http//leg1.state.va.us/cgi-bin/legp504
  • Section 504 of the Rehabilitation Act of 1973
    Requires all public schools to afford children
    with disabilities (including diabetes) an equal
    opportunity to participate in all academic as
    well as nonacademic and extracurricular services
    and activities regardless of disability.

Diabetes Medical Management Plan
  • A medical management plan must be provided for
    each student with diabetes (Individualized Health
    Care Plan IHCP) completed by the students
    medical management team and signed by both the
    health care provider and the students parent.

Components of the Plan
  • Contact Information parent and provider
  • Blood glucose monitoring when, where, and how
    independent the student is
  • Insulin when, type, amount, how (pen, syringe,
    pump), by whom (student, nurse)
  • Diet Meals and snacks time, amount
  • Treatment/management of low blood sugar.
  • Treatment/management of high blood sugar.

  • Blood glucose testing
  • Insulin administration
  • Diet carb counting
  • Exercise
  • Recognizing and treating high blood sugar and low
    blood sugar
  • Emergency treatment of severe low blood sugar

Blood Glucose Monitoring
  • Different kinds of meters
  • Must be calibrated to match test strips

Examples of Glucometers
  • Freestyle One Touch Ascenia

When to Check Blood Glucose
  • Students may check their blood glucose
  • Before eating snacks or meals
  • Before physical activity
  • When they have symptoms of low or high blood
  • Other times per plan

Blood Glucose Monitoring Skills
  • Wash dry hands.
  • Insert test strip in glucose meter
  • Select appropriate site on the fingertip (top or
  • Puncture fingertip accurately and obtain optimal
    amount of blood to perform accurate measurement.
  • Place drop of blood on test strip.
  • Obtain accurate reading.
  • Record blood glucose results.

  • All people with Type 1 Diabetes manage their
    diabetes with insulin.
  • Old method Long-acting (basal) insulin and 2
    doses of intermediate acting insulin.
  • New method Long acting (Lantus, Levemir,
    Ultralente) and 3 shorter acting doses
    (Humalog/Novalog) at mealtimes based on amount of
    carbohydrates in meal.

Carbohydrate Counting
  • Used in conjunction with a combination of long
    acting (eg. Lantus) once a day with short acting
    (Humalog or Novalog) with each meal.
  • Easier to learn than Exchanges or the Point
  • Food and insulin match better.
  • Increased variety of food choices.
  • More flexibility in meal/snack times.
  • Better blood sugar control.
  • Carbohydrate information on food labels makes
    meal planning easier.
  • Focus is on carbohydrates, but protein and fat
    are still important.
  • Count total carbohydrates.

Food Label
Nutrition Facts Nutrition Facts
Serving Size 1 cup (253 g) Servings per container 2 Serving Size 1 cup (253 g) Servings per container 2
Amount per serving Daily Values
260 calories
Total fat 8 g 13
Sat. fat 3 g 17
Cholesterol 130 mg 44
Sodium 1010mg 42
Total Carbohydrate 22 g 7
Dietary Fiber 9 g 36
Sugars 4 g
Protein 25 g

Tools for Carbohydrate Counting
  • Albemarle County Child Nutrition Services
  • USDA
  • http//www.nal.usda.gov/fnic/foodcomp/search/
  • Fast food
  • http//www.bddiabetes.com/resource.aspx?IDX4253

Types of Insulin, Dosages Times Sample Plan
Insulin Pre-Breakfast Humalog Pre-Lunch Humalog Pre-Dinner Humalog
Lantus 10 units before breakfast Daily Carb Ratio _1__ units for every15_ grams carbs eaten Carb Ratio _1__ units for every 15 grams carbs eaten Carb Ratio 1 units for every 15 grams carbs eaten
Adjust for blood glucose reading Correction Factor Add 1 unit for every 50 mg/dl above 150 Subtract 1 units for every 20 mg/dl below 100 mg/dl Correction Factor Add 1 unit for every 50 mg/dl above 150 Subtract 1 units for every 20 mg/dl below 100 mg/dl Correction Factor Add 1 unit for every 50 mg/dl above 150 Subtract 1 units for every 20 mg/dl below 100 mg/dl
If dose is half unit, round up. For Carb count round down If dose is half unit, round up. For Carb count round down If dose is half unit, round up. For Carb count round down

Calculating Insulin Dose Pens and Pumps
  • Determine amount based on plan
  • Step 1 Calculate number of carbs in meal then
    determine the prescribed ratio (eg. 1 unit for
    each 15 grams carbs).
  • Step 2 Correction factor for blood glucose
    reading (add insulin for higher blood sugar
    reading and subtract for lower reading).

Example from Sample Plan
  • Students lunch contains 60 grams of carbs and
    his blood sugar reading is 160mg/dl.
  • Step 1 1 unit for each 15 grams 4 units
  • Step 2 Correction factor add 1 unit for blood
    sugar reading of 160mg.
  • Insulin dose 5units

More Examples from Sample Plan Calculating
Insulin Dose
Grams of carbs Blood Sugar Amount of Insulin (Dose)
80 g (5.3 units round down) 80 mg/dl (minus 1 unit) 4 units
75 g (5 units) 360 (plus 5 units) 10 units
65 g (4 units round down) 90 (no correction) 4 units
100 g (6 units round down) 175 (plus 1 unit) 7 units
Insulin Chart
Types of Insulin Injections
  • Types of Insulin Injections
  • Vials and syringes
  • Insulin pens
  • Insulin pumps

Insulin Vials and Syringes
  • Insulin Vial and Syringes

Insulin Pens

Insulin Pumps

For All Types of Insulin Skills
  • Determine appropriate storage security of
    insulin, syringes, medical supplies.
  • State where plan is located.
  • State 5 rights of medication administration
    student, medication, dose, time and route.
  • Determine insulin dose per plan.
  • Document amount of insulin and time of

Insulin Types
Preparing for Insulin Injection Steps 1 through 4
  • Step 1 Remove cap
  • Step 2 Wipe the top with alcohol swab
  • Step 3 Draw air into the syringe equal to the
  • Step 4 Put the needle through the rubber top of
    the vial and push the plunger to inject air into
    the vial

Preparing for Insulin Injection Steps 5 through
  • Step 5 Draw up dose Leave syringe in the vial
    and turn both upside down. Hold the syringe and
    fial firmly in one hand. Make sure the tip of
    theneedle is in the insulin
  • Step 6 Check for bubbles Before you take the
    needle out of the vial, check the syringe for
  • Step 7 Tap to release If bubbles are in the
    medicine, hold the syringe straight up and tap
    the side of the syringe until the bubbles float
    to the top. Push the bubbles out with the
    plunger and draw the insulin back in until you
    have the correct dose.

Injection Instructions
  • Gather together the insulin-loaded syringe or
    pen, an alcohol swab and a dry cotton swab or
  • Select the injection site (illustration).
  • Swab the site with an alcohol swab.
  • Gently pinch up the skin and fat with the thumb
    and forefinger.
  • Hold the syringe like a pencil, close to the
    needle for better control.
  • Push the needle in quickly and all the way, at a
    90-degree angle to the pinched-up skin.
  • Push the plunger in to inject the insulin.
  • Slowly let go of the pinched-up skin and then
    remove the needle.
  • Using a dry swab, apply gentle pressure to the
    injection site to prevent bruising.
  • Discard the needle and syringe in the sharps
    container. To avoid possible injury, never leave
    used needles lying around.

Insulin Pen Injection Skills
  • Determine amount of insulin to be administered
    based on plan.
  • Prepare pen by applying needle appropriately.
  • Prime the pen with 2 units dial 2 and push
    plunger to dispense the two into trashcan.
  • Dial the correct dose to be administered.
  • Demonstrate accurate injection technique.
  • Dispose of used needle correctly.
  • Document amount of insulin and time administered.

Insulin Vials and Syringes Skills
  • Assemble supplies vials, syringes, alcohol
  • Accurately measure insulin dose with syringe.
  • Locate appropriate sites for injection.
  • Demonstrate accurate injection technique.
  • Dispose of syringes in sharps container.
  • Record amount of insulin and time administered.

Insulin Pumps
  • Pumps vary by manufacturer.
  • Calculate amount of bolus at meal time per plan.
  • Enter the amount on pump per instructions.
  • Record the amount of bolus.

Hyperglycemia (High Blood Sugar)
  • Causes of Hyperglycemia
  • Too much food
  • Too little insulin
  • Decreased activity
  • Illness
  • Infection
  • Stress

Symptoms of Hyperglycemia
  • Mild
  • Thirst
  • Fatigue/sleepiness
  • Increased hunger
  • Blurred vision
  • Weight loss
  • Stomach pains
  • Flushing of skin
  • Lack of concentration
  • Sweet fruity breath
  • Moderate
  • Any of the mild symptoms
  • Dry mouth
  • Nausea
  • Stomach cramps
  • Vomiting
  • Severe
  • Any of the mild or moderate symptoms plus
  • Labored breathing
  • Very weak
  • Confused
  • Unconscious

Symptoms of Hyperglycemia
Treatment for Hyperglycemia High Blood Sugar
  • Allow free use of the bathroom.
  • Encourage student to drink water.
  • Check urine for ketones per plan.
  • Follow instructions in plan.
  • Students who test positive for ketones should not
    participate in p.e. or sports until ketones are
    no longer present.
  • Call parent for high blood sugar per plan.
  • Some students plan will state that the student
    needs to go home for blood sugar above a certain
    number (300 or higher depending on the plan).

Hypoglycemia Low Blood Sugar
  • Causes of low blood sugar
  • Too much insulin
  • Missed food
  • Delayed food
  • Too much or too intense exercise

Symptoms of Hypoglycemia
  • Moderate
  • Headache
  • Behavior change
  • Poor coordination
  • Blurry vision
  • Weakness
  • Slurred speech
  • Confusion
  • Severe
  • Loss of consciousness
  • Seizure
  • Inability to swallow
  • Mild
  • Hunger
  • Shakiness
  • Weakness
  • Paleness
  • Anxiety
  • Dizziness
  • Sweating
  • Drowsiness
  • Personality change
  • Inability to concentrate

  • A student who complains of feeling low or who
    you suspect may be low should never be sent to
    check blood glucose, to go the nurses office or
    anywhere else alone. The student could lose
    consciousness or become disoriented.

Treatment of Mild Hypoglycemia
  • Follow plan for parameters for treatment.
  • Provide quick acting source of carbohydrates such
    as juice or glucose tablets per plan.
  • Wait 10 to 15 minutes and recheck blood glucose.
  • Student may self treat if permitted by plan.

Treatment of Moderate Hypoglycemia
  • Student will need assistance/supervision.
  • Give quick acting carbohydrate per plan.
  • Wait 10 to 15 minutes and check again.
  • Follow parameters of plan for how much
    carbohydrate to give and when to repeat if
  • May administer glucose gel or icing if student is
    low but conscious and able to swallow.

Hypoglycemia Mild to Moderate (Skills)
  • State signs of hypoglycemia.
  • State treatment of mild to moderate hypoglycemia.
  • Describe use of glucose gel or icing for
    treatment of hypoglycemia.

  • A hormone that is made naturally in the pancreas.
    It releases stores of glucose from the liver
    causing blood glucose levels to rise. Because it
    is produced naturally it is a safe drug -- it
    cannot be overdosed and it has no major side
  • Glucagon injection is used for severe
    hypoglycemia when the diabetic is unable to
  • When injected it causes blood sugar to rise and
    the person to regain consciousness.
  • Glucagon is to be injected into the muscle of the
    legs, arms or buttocks.

Treatment of Severe Hypoglycemia GLUCAGON
  • Glucagon Kit Lilly
  • For video on glucagon administration see

Glucagon Instructions Steps 1 - 3
  • Remove the flip off seal from the bottle of
    glucagon. Wipe rubber stopper on bottle with
    alcohol swab.
  • Remove the needle protector from the syringe and
    inject the entire contents of the syringe into
    the bottle of powdered glucagon. Do not remove
    the plastic clip from the.
  • Swirl bottle gently until the glucagon dissolves
    completely. Do not shake shaking may cause
    bubbles to form. Glucagon should not be used
    unless the solution is clear and of a water-like

Glucagon Instructions Steps 4 through 8
  • Using the same syringe, hold bottle upside down
    and making sure the needle tip remains in the
    solution, gently withdraw all of the solution
    from the bottle. The plastic clip on the syringe
    will prevent the rubber stopper from being pulled
    out of the syringe.
  • Clean the injection site on buttock, arm, or
    thigh with alcohol.
  • Insert the needle into the loose tissue and
    inject the amount (half or all per plan). Apply
    light pressure at the injection site and withdraw
    the needle.
  • Turn person on side.
  • As soon as patient is able to swallow give fast
    acting sugar such as juice or soft drink followed
    by a long acting source of sugar such as crackers
    and cheese or a meat or peanut butter sandwich.
    Sprite or ginger ale work well if stomach is

Severe Hypoglycemia Glucagon Skills
  • Accurately state when Glucagon should be
  • Describe how to mix and withdraw Glucagon from
  • Determine dose based on plan (0.5mg or 1.0mg).
  • Locate appropriate injection sites and injection
    technique (intramuscular).
  • Precautions turn child on side, call 9-1-1
    state it is a diabetic emergency, call parents.
  • Give quick acting carbohydrate such as soft drink
    (NOT DIET) when student is awake and can
  • Document time and amount of Glucagon

Sample Log
  • As school personnel we want to ensure that
    all of our students learn and prosper in school.
    By understanding the basics of diabetes and
    knowing how to care for a student with diabetes,
    you will be able to help your student take
    advantage of all of the learning and growing
    opportunities your school has to offer. Thank
    you for interest and willingness to help your
    student with diabetes succeed and thrive in
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