Medical Management for Children with Diabetes 2015 Safe at School: Medical Management for Children with Diabetes

Objectives At the end of this learning session participants will be able to: Describe how the anaphylaxis law affects treatment students with diabetes will receive State the importance of diabetes self-management Discuss treatment for hyperglycemia Discuss treatment for hypoglycemia

Anaphylaxis Law Food items containing peanuts removed Supplies needed for school Snack Treatment

Additional Changes Diabetes Medical Management Plan Date Diagnosis CGM Type 1 vs Type 2 CGM Treatment Hyperglycemia Hypoglycemia Insulin orders Type 2

TREATMENT AND INTERVENTION FORM MANAGEMENT PLAN (1) Date of Plan: __________ DIABETES MEDICAL MANAGEMENT PLAN Expiration date: ______________ (2)  Insulin Dependent Diabetes DIAGNOSIS:  Type 1 Type 2  Other Diabetes ________________________ (3) Continuous Glucose Monitor (CGM):  Yes  No Brand/Model: _______________________: CGM may be worn for daily or occasionally Note: Confirm CGM results with blood glucose meter check before taking action on sensor glucose level. No medical treatment should be rendered based on CGM result only. If student has symptoms or signs of hypoglycemia, check fingertip blood glucose level regardless of CGM. TREATMENT AND INTERVENTION FORM Student’s Name: _______________________________________________________ Date of Birth: _________________ Begin Treatment_____________________________________ Stop Treatment______________________________ Date Date DO NOT DISCARD THIS FORM UNTIL THE STOP DATE AS LISTED ABOVE

Diabetes Self-Management

Diabetes Self-Management Importance: Gain knowledge Learn and practice skills Modify behavior Successfully self-manage Diabetes self-management education is also known as diabetes self-management training. DSME/DSMT is a collaborative process. People with diabetes or at risk for diabetes work with their healthcare providers and other health care professionals learning about the diabetes process. Hopefully, the collaborative interaction will equip patients and families to: Gain the knowledge to understand the disease Introduce them to new skills such as monitoring blood sugars, check urine/blood ketones, count carbs, inject insulin, &/or receive pump training Modify behaviors by changing lifestyle. For example, The knowledge can empower families to successfully self-manage diabetes and its related conditions. This process is on-going for the students and Y O U, as school nurses, play a major part in reinforcing their education.

Diabetes Self-Management Treatment and Intervention Form Self-care skills Blood glucose testing NA Ind supv total kept Ketones testing NA Ind supv total kept Glucose/gel NA Ind supv total kept Count carbohydrates NA Ind supv total Calculate insulin dose NA Ind supv total Give insulin by injection NA Ind supv total kept Give insulin by pump NA Ind supv total kept Change infusion set NA Ind supv total kept

Diabetes Self-Management Treatment and Intervention Form Blood glucose monitoring When to check: Before meals Anytime s/s high/low blood glucose Urine Ketones testing Greater than 300 Student sick and /or vomiting Glucose tablet/gel When to use: Treat hypoglycemia

Diabetes Self-Management Definition: Ind = independent self-management Supv= self-management with nurse supervision Total = total care by nurse Kept = kept on person NA = does not apply to my child; my child is not doing or using this

Insulin Orders Review Original orders from state COA orders Pump Correction factor + carbohydrate ratio Correction factor + fixed Sliding scale + fixed Sliding scale + carbohydrate ratio

Insulin Orders Original Form

Insulin Orders Pump Therapy

Insulin Orders Correction + ratio

Insulin Orders Sliding Scale + Fixed

Insulin Orders Insulin Orders

Treatment: Hyperglycemia Hypoglycemia

Hyperglycemia Injections

Hyperglycemia Pump Therapy

Case Studies

Hypoglycemia Injections

Hypoglycemia Pump Therapy

Case Studies

Type 2 Student has Type 2 Diabetes Able to control their blood sugar levels by managing their weight, eating healthy meals and getting plenty of exercise. However, if not enough…may have been medications that are taken by mouth and/or by injections. These medications are not administered during school hours. At times this student may have high blood sugars. High blood sugar (hyperglycemia) in people with diabetes can often cause unusual thirst and the need for frequent urination. If this occurs, he/she will probably need to go to the restroom more often than usual. Please allow him/her the freedom they need on these occasions to do so. A balanced intake of milk products, fruits, vegetables, breads and meats is the meal plan Concentrated sweets (candy, sweet rolls, cake, chocolate milk, etc.) should be avoided. Students with diabetes may eat anything on breakfast or lunch trays except desserts and drinks containing sugar. We have encouraged him/her to substitute fresh fruit or fruit packed in natural juice (not syrup) for their dessert. Additionally, we have instructed this student to test his/her blood sugar any time he/she is not feeling well. If the student is required to test his/her blood sugar a treatment intervention form will be sent to the school. This is considered a minimal standard for safety in the school setting and is covered under the Americans with Disabilities Act.

How Can You Assist Children’s (COA) All communication to COA must contain name of student and date of birth Make sure you send glucose readings home. Caregivers need this information when communicating with COA. It is ok to fax the readings from school; however, we need all readings We have a revised fax sheet for families needing assisting

Questions

References: AADE (2011). Diabetes Self-Management. The Art and Science of Disease Self-Management Education Desk Reference;(2) 22-24. NDEP (2010). Helping the Student with Diabetes Succeed. A Guide for School Personnel. Pediatrics (2012). Policy statement- Guidance for the Administration of Medication in School. Retrieved from http://pediatrics.aappublications.org/content/124/4/1244.full.html