CHILDREN WITH DIABETES AT SCHOOL

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CHILDREN WITH DIABETES AT SCHOOL

• Diabetes Specialist Nurses

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What is diabetes?

• Diabetes is a condition in which the level of
  glucose or sugar in the blood is higher than
  normal because the body is unable to use it
  properly.
• This is because the bodys method of converting
  glucose into energy is not working as it should

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Insulin

• This is a hormone that is made in the Pancreas
  (which is a gland that lies behind the stomach)
• Insulin helps the glucose or sugar that we eat to
  enter the cells where it is used by the body to
  give us energy

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Children With Diabetes

• Most children will have type 1 diabetes
• They can no longer produce insulin because the
  cells of the pancreas that produce insulin are
  destroyed
• Without insulin the childs body cannot use
  glucose and the blood glucose level rises.

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Person with diabetes
Person without diabetes

• Eats a meal
• Blood sugar rises
• Insulin is released
• Blood sugar falls

• Eats a meal
• Blood sugar rises
• No insulin/insufficient insulin is released
• Blood sugar does not fall

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Symptoms of diabetes

• Increased thirst
• Going to the toilet frequently
• Extreme tiredness
• Weight loss
• Blurred vision
• Teachers are often in a position to notice the
  signs that a child may have diabetes

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Treating diabetes

• Most children are treated with a combination of
  insulin and a balanced diet
• Insulin has to be injected it is a protein that
  would be broken down in the stomach if it was
  swallowed like a medicine

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Treating diabetes

• Majority of children take 4 injections per day
  and will need to inject insulin at school. This
  is not because their diabetes is worse or
  harder to control.
• Taking more injections allows more flexibility in
  lifestyle, better concentration and better
  behaviour.
• Some children may be on an insulin pump.

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Administering insulin at school

• The children that are on four injections or an
  insulin pump will have to administer insulin at
  lunchtime. The treatment regimen will be
  documented in their individual care plan. The
  Diabetes Specialist Nurse and parents will visit
  individual schools to discuss diabetes care when
• the child is newly diagnosed
• requires a change to their treatment
• moves to a new school
• problem with diabetes at school

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Administering insulin at school

• The school will need to identify an appropriate
  area where administration of insulin and blood
  glucose monitoring can be carried out
• In some circumstances the child may require
  assistance with the administration of insulin
  and/or blood glucose monitoring.
• If a lunch time injection is required the parent
  will contact the school to identify appropriate
  staff to administer the insulin.

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• Once the school has identified the appropriate
  people, a training programme will be provided.
• This will be discussed at the individual meeting
  and documented in the childs care plan.

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Diet

• The diet for children with diabetes is based on
  the balanced varied diet which is recommended for
  every child low in fat and sugar high in
  fibre
• The child and family will have seen a Dietitian,
  who will have advised on suitable food choices
  and discussed any particular needs to staff.

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Eating Times

• Meals and snacks should be eaten at regular
  intervals following a plan discussed by the
  family and their Dietitian
• A missed or delayed meal could lead to low blood
  sugar Hypoglycaemia. The child should eat all of
  their lunch to prevent a hypo occuring.

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Eating times

• It may be necessary on occasions to allow the
  child to have a snack in class, but it is best
  eaten at break time to avoid any fuss.
• If you feel the class should understand why the
  child is having a snack first ask the child how
  they feel about their diabetes being discussed
  with the class.

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Snacks

• The choice of food will depend on the individual
  child but should include
• Sandwich
• Cereal bar
• Portion of fruit
• Two biscuits

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Hypoglycaemia (Hypo)

• Hypoglycaemia is the most common short-term
  complication in diabetes and occurs when the
  blood sugar is too low
• The symptoms can be different for each child and
  are documented on their individual care plan
• Most children recognise a hypo and will take
  appropriate action themselves

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Possible causes of Hypoglycaemia

• Too little food for the insulin taken
• Not enough food to fuel an activity
• A missed or delayed snack

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Signs and symptoms of hypoglycaemia

• Sweating
• Trembling/shakiness
• Drowsiness
• Headache
• Lack of concentration

• Hunger
• Pallor
• Glazed eyes
• Mood changes especially angry or aggressive
  behaviour

Each child will have their particular signs and
symptoms and these will be documented on the
individual care plan
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Treating a hypo

• It is VERY important that a hypo is treated
  quickly.
• If left untreated the blood glucose levels will
  continue to fall and the child could become
  unconscious.
• The child should not be left alone during a hypo
  nor sent of to get food to treat it. Recovery
  treatment must be brought to the child.

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What To Do

• Immediately give something sugary e.g.
  Lucozade, Fresh Fruit Juice, Glucose Tablets, Non
  Diet Fizzy Drink
• The exact amount may vary from person to person
  parents or carer will advise and it will be
  documented in the care plan
• Glucogel, honey or jam may be massaged into
  childs cheek if they are too drowsy to take
  anything themselves

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Follow With

• Starchy food to prevent blood sugar dropping
  again
• snack eg sandwich, cereal bar, portion of fruit,
  2 biscuits
• or lunch time meal if due
• If the child is unconscious do not give anything
  to eat or drink call an ambulance

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Following treatment

• Following treatment for hypo the child should
  continue with normal school activities.

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Physical activity

• Diabetes should not stop children from enjoying
  any kind of physical activity or being selected
  to represent their school providing they have
  made simple preparations
• Preparations are needed because all forms of
  physical activity use up glucose

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Physical activity

• The more strenuous and prolonged the activity
  the more food will be needed, before, and
  possibly during and afterwards. It may also be
  beneficial to test during exercise.
• BEFORE ACTIVITY
• The child may require an extra snack

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Physical activity

• DURING ACTIVITY
• There should be glucose tablets or sugary drink
  nearby.
• AFTER ACTIVITY
• The child may require some starchy food eg packet
  of crisps but this will depend on how strenuous
  the activity was.

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Other Considerations

• Sickness
• If child is unwell blood sugars may rise, it may
  happen even with a simple cold.
• The child may become thirsty and run to the
  toilet frequently
• This should be reported to parent/carer as
  insulin adjustments may be necessary

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Blood Glucose Monitoring

• Most children with diabetes will need to test
  their blood glucose levels on a regular basis.
  They may need to do this at school.
• Blood glucose testing involves pricking the
  finger, using a special finger-pricking device
  and a blood glucose meter.
• If tests are required at school the parents can
  advise how often they should be done.

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School Trips

• Should not cause any real problem
• Child should take their injection kit and blood
  glucose monitoring kit in case of delay
• Extra snacks should be taken

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Overnight Stays

• No problem as long as
• Child is able to do own injection and blood
  glucose monitoring
• A member of staff is willing to take the
  responsibility of helping with this in the
  younger/less able child

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Going Abroad

• It is important that travel insurance will cover
  pre-existing conditions such as diabetes
• Travel and diabetes Individual advice provided
  by Diabetes Specialist Nurse. Diabetes UK
  publication gives advice on managing diabetes
  away from home

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Points of Contact for Diabetes Specialist Nursing
Service

• Armagh Dungannon Locality
• Olivia Creaney Tel No [phone]
• Craigavon Banbridge Locality
• Pauline Ingram Tel No [phone]
• Newry Mourne Locality
• Janette Newell Tel No [phone]