DIABETES MELLITUS Type 1 By Dana Beaver, RN

(Selekman, J., 2006) Diabetes Mellitus Is one of the oldest conditions known to man, having been identified in 1500 B.C. (Selekman, J., 2006)

What is Diabetes? Diabetes is a disease in which the body does not produce or properly use insulin Insulin is a hormone that is needed to convert sugar, starches and other food into energy for daily life (American Diabetes Association [ADA], 2009)

Diabetes Mellitus There are a number of different types of Diabetes Type 1 and Type 2 are the most common type in children and adolescents This presentation will focus on Type 1 Diabetes (Selekman, J., 2006)

Diabetes Mellitus Type 1 Approximately 1 in 400-600 children and adolescents have Type 1 Diabetes Type 1 Diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose To survive, people with Type 1 Diabetes must have insulin delivered by injection or by pump (ADA, 2009)

Causes of Diabetes Type I The body produces insufficient insulin, or the insulin is ineffective Causes include: predetermined genetic susceptibility, and environmental factors Other causes are particular viruses and toxins (Lewis, K., and Bear, B., 2009)

Management of a Student with Diabetes Type 1 Management of a child with diabetes is a vital part of a student’s academic experience The school nurse will develop the Individualized Healthcare Plan (IHP) and the Emergency Care Plan (ECP), in accordance with the medical plan These plans will be available to treat the student’s diabetic needs while at school Some students will require an Individualized Educational Plan (IEP) or a 504 Plan (Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D., 2005)

Medical Treatment of Diabetes Type 1 Individuals with Diabetes Type 1 require insulin injections to sustain life The student will need to check their blood glucose level during the day, using a blood glucose monitoring device Supplies will be kept in health office (insulin, syringes, test strips, insulin pump equipment) (Lewis, K., and Bear, B., 2009)

Blood glucose monitoring

Medical Treatment (continued) A student with Type 1 Diabetes will need to give self injections of insulin, after testing their blood glucose level in the health office ,several times during the day (according to their medical plan) (Lewis, K., and Bear, B., 2009)

Medical Treatment (continued) A student with Type I Diabetes may wear an insulin pump A student will still require to test their blood glucose during the school day They will need to make adjustments on their insulin pump (Lewis, K., and Bear, B., 2009)

INSULIN PUMP

Reactions while in school Two reactions a student may have while in school related to using insulin HYPERGLYCEMIA- blood glucose too high HYPOGLYCEMIA- blood glucose too low (Lewis, K., and Bear, B., 2009)

HYPERGLCEMIA Blood glucose too high Hyperglycemia is when a blood glucose level is greater than 240 mg/dl Onset of hyperglycemia is slow Causes of hyperglycemia: missed insulin doses eating more food than planned illness certain medications (Selekman, J., 2006)

Signs or student complaints that may indicate high blood glucose (HYPERGLYCEMIA) Increased thirst and urination Flushed skin Nausea, vomiting Weakness and drowsiness Fruity breath If untreated, can cause unconsciousness (Lewis, K., and Bear, B., 2009)

Serious condition related to HYPERGLYCEMIA Diabetic Ketoacidosis (DKA) is a serious and complicated condition, when there is too much glucose in the bloodstream and cannot be properly utilized by the body. It occurs from profound insulin deficiency If DKA is untreated it can progress to coma (Silkworth et al., 2005)

DIABETIC EMERGENCY ALL students who take insulin are at risk for low blood sugar (HYPOGLYCEMIA) Children with Diabetes are taught by their diabetes educator and doctors if they experience symptoms of hypoglycemia, to treat with/without a blood glucose measurement (Silkworth et al., 2005)

HYPOGLYCEMIA Blood glucose too low Hypoglycemia is defined as a blood glucose level that is less than 70 mg/dl Hypoglycemia can have a rapid onset Hypoglycemia is a medical emergency Causes of hypoglycemia: too much insulin meals and snacks delayed or missed extra exercise or activity (Lewis, K., and Bear, B., 2009)

Signs or student complaints that may indicate low blood glucose (HYPOGLYCEMIA) Mild Signs hunger irritability shakiness weakness, anxiety inability to concentrate not feeling well “feel funny” (Lewis, K., and Bear, B., 2009) Moderate to severe confusion slurred speech slow thinking sleepiness erratic behavior unconsciousness seizures

Diabetic Emergency DIABETIC STUDENTS WITH SIGNS OR COMPLAINTS OF HYPOGLYCEMIA NEED TO GO IMMEDIATELY TO NURSE ACCOMPANIED WITH A BUDDY OR STAFF MEMBER Symptoms can worsen quickly! NEVER leave a student unattended in case their blood glucose level goes too low and they lose consciousness Treatment will be followed according to medical plan, IHP and ECP (Silkworth et al., 2005)

Sample Treatment of HYPOGLYCEMIA Give student fast acting carbohydrates (fruit juice, glucose tabs, regular soda pop) if awake and alert If unconscious, Glucagon intramuscular would be given If uncertain whether a student is hyperglycemic or hypoglycemic, always treat for hypoglycemic (Silkworth et al., 2005)

Possible Effects on Individual Student Poor self-image as a result of being “different” Altered mood and mental alertness Risk for depression, doubles Parental relationships may be strained from having parent who does too much or too little May feel insulin injections are form of punishment Unable to participate in certain sports, which may be due primarily to parental concerns May not be able to eat “all foods” at a class party (Lewis, K., and Bear, B., 2009)

Long Term Type 1 Diabetes Complications Heart disease- Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation Kidney disease- Diabetes can damage the kidneys which can cause them to fail Eye complication- Diabetes can cause eye problems and may lead to blindness Nerve damage- Diabetes can cause neuropathy (nerve damage), which is one of the most common complications Foot complications- can happen when there is nerve damage or poor circulation to the feet Skin complications- As many as one-third of people with Diabetes will have a skin disorder Depression- Diabetes increases a persons risk for depression (ADA, 2009)

The Teacher’s Role in Diabetic Management Be Helpful- Assist students as needed. Follow IEP or 504 plan accordingly Be Observant- Notice when students are showing signs that something isn’t right Be Supportive- If a student is having difficulty, approach and support in a reassuring manner and……. Be Calm- Call or send for the school nurse

References American Diabetes Association. (2009). Retrieved April 5, 2009, from http://www.diabetes.org/ Lewis, K., & Bear, B. (2009). Manual of school health: a handbook for school nurses, educators, and health professionals. California: Saunders. . Selekman, J. (2006). School nursing: a comprehensive text. F.A. Philadelphia: Davis Company. Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D. (2005). Individualized healthcare plans for the school nurse: concepts, framework, issues, and applications for school nursing practice. Minnesota: Sunrise River Press.