Care for School Children With Diabetes Senate Bill 911/G.S. 115C-47

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Care for School Children With DiabetesSenate
Bill 911/G.S. 115C-47

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OVERVIEW OF SB 911

• SECTION 2
• Requires local school systems (LEAs) to ensure
  that guidelines are implemented to schools in
  which students are enrolled
• LEA will make available necessary information and
  staff development in order to support the
  diabetes care plan requirements for students with
  diabetes

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OVERVIEW OF SB 911

• SECTION 1
• Requires procedures for the development of a
  diabetes care plan if requested by parents
• Procedures must include provisions for a
  regular review
• Key components to include
• Staff development for all school staff
• Development of an emergency care plan, including
  allowable actions to be taken
• Extent of the students control of diabetes care

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Diabetes Awareness, Training and Action (DATA)

• Diabetes mellitus is a group of metabolic
  diseases characterized by hyperglycemia (high
  blood sugar) resulting from defects in insulin
  secretion, insulin action, or both.
• Diabetes Care Supplement, 2003

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Diabetes Awareness

• Insulin is a hormone produced in the beta or
  islet cells in the pancreas
• It is necessary to move the sugar (glucose) in
  the bloodstream into the cells for metabolism to
  occur
• Glucose is essential to life and to keeping the
  cells in the body healthy

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Diabetes Awareness

• Type 1 Diabetes
• Used to be known as Juvenile-Onset or Insulin
  Dependent Diabetes
• Results from the autoimmune destruction of the
  beta (or islet) cells of the pancreas which
  produce the hormone insulin
• A person cannot live without insulin

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Diabetes Awareness

• Type 1 Diabetes
• Occurs in approximately 1400 children (10 of
  the diabetic population)
• Often presents as an acute illness
• Requires insulin injections

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Diabetes Awareness

• Type 2 Diabetes
• Used to be known as Adult-Onset or Non-Insulin
  Dependent Diabetes
• Characterized by insulin resistance that develops
  into insulin deficiency
• Is a rising epidemic among young people
• Central abdominal obesity is directly related to
  Type 2 diabetes

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Diabetes Awareness

• Type 2 Diabetes
• Accounts for 90 of the worlds population with
  diabetes
• Insulin resistance means that insulin is
  produced, but the body is not using it correctly
• This resistance causes blood sugar levels to
  rise, resulting in diabetes

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Diabetes Overview Treatment Foundations

• The amount of insulin taken has to be balanced
• with
• food intake (specifically, carbohydrates)
• and
• levels of activity.

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Diabetes Overview Treatment Foundations

• Currently, most students are taking insulin by
  syringe, pen device or pump.
• The insulin pump is a type of injection using a
  very small catheter under the skin that
  continuously provides insulin
• The food intake is monitored by counting carbs
  in the nutrition plan

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Diabetes Overview Treatment Foundations

• Tools for Diabetes Management
• Self-monitoring of blood sugar levels
• Is important for everyone with diabetes
• Is done by a blood glucose meter reading a drop
  of blood
• Is recorded in the persons log

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Diabetes Overview Treatment Foundations

• Tools for Diabetes Management
• Carbohydrate Counting and Meal Planning
• To balance activity insulin
• To calculate the dosage of insulin to administer
• To achieve and maintain a healthy weight level

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Diabetes Overview Treatment Foundations

• Tools for Diabetes Management
• Insulin Injection
• Most students take at least two insulin
  injections daily
• Some are on intensive insulin therapy or wear a
  pump

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Diabetes Overview Treatment Foundations

• Tools for Diabetes Management
• Senate Bill 911 Management Tools are to be
  available to the student at all times, in
  accordance with the individual diabetes care plan

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Diabetes Overview Acute Complications

• HYPERGLYCEMIA High Blood Sugar
• Occurs when the body gets
• Too little insulin, OR
• Too much sugar in the food eaten, OR
• Too little activity/physical exercise
• Hyperglycemia may also occur when the child has
  an illness, such as a cold

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Diabetes Overview Acute Complications

• HYPERGLYCEMIA Symptoms
• Frequent Urination
• Extreme Hunger
• Extreme Fatigue
• Unusual Thirst
• Irritability
• Blurred Vision

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Diabetes Overview Acute Complications

• HYPERGLYCEMIA High Blood Sugar
• In all high cases, if the student is able, s/he
  should drink lots of calorie-free, caffeine-free
  liquids, preferably water.

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Diabetes Overview Acute Complications

• HYPOGLYCEMIA Low Blood Sugar
• Occurs when the body gets
• Too much insulin, OR
• Too little sugar in the food eaten, OR
• Too much activity/physical exercise
• Hypoglycemia occurs when the body does not have
  enough sugar in the blood

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Diabetes Overview Acute Complications

• HYPOGLYCEMIA Symptoms
• Hunger
• Shakiness
• Dizziness
• Sweatiness
• Fast heartbeat
• Drowsiness

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Diabetes Overview Acute Complications

• HYPOGLYCEMIA Symptoms
• Feeling irritable
• Nervousness
• Pallor
• Stubbornness

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Diabetes Overview Acute Complications

• HYPOGLYCEMIA Symptoms
• Lack of coordination
• Tingling, numbness of the tongue
• Personality change
• Passing out
• Seizure
• Death

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Diabetes Overview Acute Complications

• RECOGNIZING HYPOGLYCEMIA
• It is important to recognize a low blood sugar as
  soon as possible so that it does not progress to
  a severe reaction
• Early signs are caused by the release of
  adrenaline (epinephrine), the fight or flight
  hormone

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Diabetes Overview Acute Complications

• FREQUENT CAUSES OF HYPOGLYCEMIA
• Meals that are late or missed
• Extra exercise or activity
• An insulin dose that is too high
• Unplanned schedule changes

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Diabetes Overview Acute Complications

• WHAT TO DO IF HYPOGLYCEMIA OCCURS
• Contact DCM
• If possible, always do a blood sugar test first
• Have student eat/drink 15 grams of a fast-acting
  carbohydrate
• Wait 15 minutes and check blood sugar

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Diabetes Overview Acute Complications

• HYPOGLYCEMIA BUSTERS
• 2-4 Glucose Tablets
• 4 ounces of orange or apple juice
• 4-6 ounces of regular soda (not diet)
• 4-8 Lifesaver candies
• 3-4 teaspoons of sugar or syrup
• 1 tube of cake icing/gel

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Diabetes Overview Acute Complications

• Treating severe hypoglycemia
• Immediate action is necessary
• Glucagon may need to be injected
• Someone should be calling 911
• Turn the person onto their side and keep
  comfortable

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DATA Summary

• SB 911 is intended to eliminate discrimination
  and provide for student support and safety for
  those with diabetes.

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DATA Summary

• Tools for Diabetes Management
• Senate Bill 911 Management Tools are to be
  available to the student at all times, in
  accordance with the individual diabetes care plan

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DATA Summary

• All treatment is based on the Diabetes Care Plan
  provided by the parent in consultation with the
  students
• health care
• provider.

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DATA Summary

• The Diabetes Care Managers (DCMs) in each school
  provide support to all the school staff who are
  directly involved in the daily school life of the
  student with diabetes.

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DATA Summary

• In the absence of a Diabetes Care Plan, the
  parent, the student or EMS/911 will have to
  assume responsibility for diabetes care for the
  student.