Type 1 diabetes management in education and children’s services

2 Learning objectives >Understands how type 1 diabetes managed? >Can identify and manage low blood glucose as per care plan. >Can identify and manage high blood glucose as per care plan. >Is aware of the health support planning needs and responsibilities of the school, child and family.

3 What happens in type 1 diabetes? >trigger is unknown; however a genetic predisposition may exist >autoimmune response >insulin producing (islet) cells in the pancreas are destroyed and no longer produce insulin >insulin is needed to move glucose out of the blood stream and into the cells for energy >insulin is needed 24 hours a day, 7 days a week, 365 days a year

4 Psychosocial considerations >managing type 1 diabetes is extremely demanding for students and their families >it is normal for families to feel overwhelmed >students may often feel ‘burnt-out’, unmotivated or isolated >always be encouraging and supportive

5 Daily care routines >insulin via injections (2-4) or a pump >balancing the insulin dose with carbohydrate intake and exercise >testing blood glucose levels (BGL’s) >managing low & high BGL’s

6. Nutrition principles >General eating principles for children with type 1 diabetes are the same as for all children (Australian Guide to Healthy Eating). >There are 3 major food group. Carbohydrates, fat and protein. >Foods containing carbohydrates directly affect blood glucose. Insulin doses are matched to carbohydrate exchanges or serves.

7 Lunch box example Can you identify the carbohydrate foods in this lunch box?

8 Blood glucose monitoring BGL’s can change according to: > carbohydrate intake > exercise pattern > emotional state > infection. Refer to individual care plan re blood glucose level targets and testing times.

9 Low blood glucose (hypoglycaemia) >hypoglycaemia occurs when the BGL is less than 4mmol/L or if there are symptoms of hypo >symptoms vary >if a hypo is left untreated the child can become very drowsy, may have a seizure or become unconscious.

10 Causes of low blood glucose (hypoglycaemia) >delayed or missed meals >not eating enough carbohydrate >too much insulin >unplanned physical activity >vomiting and nausea >refer to care plan/flowchart instructions on how to treat

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13 High blood glucose levels (hyperglycaemia) >Hyperglycaemia is when the blood glucose is higher than the target range. >Start the child’s high blood glucose care plan once the BGL has reached 15mmol/L. >Symptoms include excessive thirst, frequency of urination, blurred vision, tired and lethargic, irritability, hunger.

14 Causes of hyperglycaemia (high BGL’s) >not enough insulin >too much carbohydrate >illness/infection >stress >pump failure >refer to care plan/flowchart for instructions on how to treat

15 High BGL’s at school If the student’s blood glucose level is above 15mmol/L: >allow free water intake >allow extra toilet breaks >if child is vomiting, feels unwell or has abdominal pain, contact parents >exercise is not encouraged. Remember: high blood glucose levels cause tiredness, reduce concentration and mood changes

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19 Health support planning When preparing the care plan and flow charts consideration needs to be given to: >food at school >blood glucose monitoring >insulin administration >storage of meters >changes to routine >camps >exams eg special provisions in SACE.

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21 Responsibilities Parent/guardian >primary responsiblity for child/student health and wellbeing >changes/updates to care plan >provides equipment including BGL kit, food (hypo kits) >discusses changes in care needs with staff >participates in assessment, planning and review >provides current emergency contact details. Student/child (depending on level of development) >engaged in their care >participates and takes responsibility for aspects of self management appropriate for their age.

22 Responsibilities Principal, Director, Manager >has duty of care for child/student health and wellbeing >communicates care plan changes/updates to relevant staff >ensures systems are documented and in place for implementation of care plan >enables staff access to relevant training and information. Staff >participate in assessment, planning and review >provide health support to student according to care and support plans.

23 Community resources SA Health >Your specialist diabetes service Country Health SA >Your local diabetes education service Country Health SA - Diabetes >(08) > Diabetes SA >(08) > Diabetes Kids and Teens >