1. Diabetes Care Tasks at School: What Key Personnel Need To Know
Psychosocial Aspects
The American Diabetes Association’s Diabetes Care Tasks at School: What Key Personnel Need to Know is a training curriculum that consists of PowerPoint modules with corresponding video segments, pre-/post-tests and other helpful resources.
This training is based on and should be used in conjunction with the 2016 “Helping the Student with Diabetes Succeed: A Guide for School Personnel”, a guide developed by the National Diabetes Education Program (NDEP), which is a federally sponsored partnership of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention and over 200 partner organizations. Training participants should read the NDEP guide prior to this training in order to gain a full understanding of the requirements of appropriate school diabetes care. Participants should have a copy of the guide during this training and for future reference. The guide can be found on the web at
Some key points about the overall training:
Overall objective: The overall goal is to optimize both health and learning for students with diabetes by providing diabetes care training to school personnel about how and when to perform routine and emergency diabetes care tasks for students, under the supervision of a school nurse or another qualified health care professional. Completion of training will help prepare school personnel to perform diabetes care tasks, ensuring that health needs are addressed in times and locations when a nurse is not available.
Rationale: The school nurse, when available, is the most appropriate person in the school setting to provide care for a student with diabetes. However, many schools do not have full-time nurses. Even for schools that do, the nurse may not always be available during the school day, during school- sponsored extra-curricular activities or field trips to assist with routine care and emergency care. Trained school personnel must be available to perform and assist the student with diabetes care tasks.
August 2018

2. Goal: Optimal Student Health and Learning
Understanding psychosocial aspects of diabetes is a vital piece of a comprehensive plan.
This training component was created specifically for school nurses and other qualified health care professionals to train non-medical school personnel.
These components are:
• Diabetes Basics
• Diabetes Medical Management Plan
• Hypoglycemia
• Hyperglycemia
• Blood Glucose Monitoring
• Continuous Glucose Monitoring
• Glucagon Administration
• Insulin Basics
• Insulin by Syringe and Vial
• Insulin by Pen
• Insulin by Pump
• Ketones
• Nutrition and Physical Activity
• After-School Programs, Sports and Camps
• Before- and After- School Care
• Childcare
• Psychosocial Aspects
• Legal Considerations
This unit is Psychosocial Aspects.

3. Learning Objectives Participants will be able to understand:
Strategies to help promote overall development and well-being
What is shared-decision making
Developmental issues and their effect on diabetes
Participants will be able to understand:
Strategies to help promote overall development and well-being
What is shared-decision making
Development issues and their effect on diabetes

4. Thriving with Diabetes
Students with diabetes can do anything any other student can do
Students with diabetes are not fragile or sick
Do not let the fact that the student has diabetes influence your style when interacting with them
Remain consistent. Rules are still rules. Expectations are still expectations.
Strategies to help promote overall development and well-being may vary depending on the student’s age
Kids are kids – first and foremost. Our goal is to help you promote your student’s overall development and well-being.
Children with diabetes are not fragile. They are not sick. They can do anything any other student can do (with more planning than before).
Do not let the fact that the student has diabetes influence your style when interacting with them. Rules are still rules. Expectations are still expectations. The student’s diabetes has nothing to do with what you can expect of them. Strategies to help promote overall development and well-being may vary depending on the student’s age and we’ll discuss common developmental issues in the coming slides.

5. Shared Decision-Making
Student should be allowed to provide his or her own diabetes care at school to the extent that is appropriate based on the student’s development and experience
The extent of the student’s ability to participate in diabetes care should be agreed upon by the parent/guardian, the student’s health care provider, and school staff
The age at which a student is able to successfully perform self-care tasks vary and depend on the individual
A student’s capabilities and willingness to provide self-care should be assessed and respected
Shared decision-making with students can improve diabetes self-efficacy, adherence, and health outcomes.
The student should be allowed to provide his or her own diabetes care at school to the extent that is appropriate based on the student’s development and experience. The extent of the student’s participation should be agreed upon by the parent/guardian, the student’s health care provider, and school staff and the age at which a student is able to successfully perform certain tasks vary and depend on the individual.
A student’s capabilities and willingness to provide self-care should be assessed and respected.

6. Preschoolers and Toddlers
Explaining diabetes in a developmentally appropriate way
The importance of language/communication
Helping the child or student cooperate with injections and blood glucose checks
Strategies for cooperating with site rotation
Handling food refusals/meal time behaviors
The importance of routines and structure
Understanding if the student’s behavior is due to blood glucose or just toddler/preschooler behavior
Preschoolers and toddlers generally do best with simple but honest explanations. It’s important not to apologize for needing to give them their insulin but rather explain to them why and then include them in decisions; ideas include having the child or student choose where they get their blood glucose check or injection. Sometimes the anticipation of checks or injections are worse than the actual action so it’s often helpful to get diabetes tasks done as quickly as possible. It can be helpful to prepare the insulin and glucose meter n another room before administering; additionally, children respond to the emotional cues from other so the more anxious and distressed you are, the more distressed they will be. Distraction techniques can also help during diabetes tasks.
Toddlers and preschoolers can be picky eaters. Consistency does help and parents/guardians should discuss other strategies at home to better ensure meal time management successes.
At this age it’s not possible to tell if the child is having a difficult time, stubborn, or fussy because of the blood glucose or because they are hungry, tired or just irritable. The answer will be found in glucose checking (blood glucose and/or CGM, per Diabetes Care Plan).

7. Elementary School Telling others about diabetes Feeling different
Diabetes is unfair
Handling questions from others
“Food police”
Readiness for management
Building confidence and problem-solving skills
During elementary school, or really any age, some student’s like to share the fact that they have diabetes with their friends and classmates while some are more private. We must respect a student’s readiness.
Research does show that children who are open about their diabetes tend to cope with their diabetes better than those who keep it hidden. For those ready, some strategies to tell their friends include making sure they know it’s not contagious or caused by eating sweets. “Show and tell” at school is a way to share, with the support of the teacher.
Students may begin to feel different than their peers. Sometimes talking about what makes each person unique can help student’s see that everyone has qualities that make them different and that all differences are okay. It may also be helpful to talk about the fact that insulin helps their body work just the same as everyone else’s body – to turn their food into the energy their body needs to grow, make strong muscles, and play, just like all of their friends.
For children, the world is supposed to be fair. Diabetes is not. Give them an opportunity to tell you more about what they think and how they feel.
It’s important to understand that student’s with diabetes can include the same foods as student’s without diabetes, unless dietary restrictions are listed in the Diabetes Care Plan. Most of the time, the “food police” are people that are well-meaning but comments that the student “can’t or shouldn’t eat” eat foods may be frustrating or confusing.
A student’s capabilities and willingness to provide self-care should be assessed and respected but it’s never too early to build a student’s confidence. As you make treatment decisions, talk out-loud. This helps the student hear how decisions are made and help them for when they’re ready to participate.

8. Middle School Puberty Readiness for management
Building confidence and problem-solving skills
Planning for tests
Telling others about diabetes
Support from others
Friends, peers, online community
Feeling different
Diabetes is unfair
Handling questions from others
“Food police”
In middle school there’s still overlapping developmental issues but student’s now have the addition of puberty. As if adolescents isn’t challenging enough related to hormones. For a teenager with type 1 diabetes, it becomes somewhat of a dance. Insulin adjustments are frequent during puberty as hormones create insulin resistance. Insulin dosing and timing will be specified in the DMMP; these physician orders may include provisions for the parent/guardian and/or capable students to modify dosing.
Planning for tests at school and standardized exams is also important at this time. When children don’t feel well, they are less likely to perform to the best of their ability on exams. A plan for the student to perform to the best of their ability should be outlined in their 504/DMMP. Some examples of accommodations include: taking breaks to use the bathroom, taking breaks for a snack and delaying testing (if glucose is high or low) without penalty.

9. High School Telling others about diabetes Puberty
Support from others
Friends, peers, online community
Feeling different
Diabetes is unfair
Handling questions from others
“Food police”
Puberty
Readiness for management
Building confidence and problem-solving skills
Planning for tests
Risk taking behaviors
Preparing for life beyond High School
Overlapping developmental issues continue into High School. However, generally in adolescence or in High School is now when boundaries are redefined and typically become more flexible to allow for increased autonomy and independence (freedom with responsibility). This can be a time of increase conflict and risk-taking or experimental behaviors may occur; this may include not taking insulin, experimenting with smoking, drugs or alcohol) as adolescents test their limits. Because adolescents typically live in the here-and-now, they tend to feel invulnerable to long-term complications.
Preparing for life beyond High School can be tricky, with or without diabetes. Particularly if they are planning on going away for college they will need to begin thinking about having a more active role in their diabetes. Many colleges have a diabetes network on campus (College Diabetes Network) to look into; if none they can even create one if interested.

10. Tips
Talk about normal, regular, every day things before talking about diabetes
Pay attention to your tone of voice when you discuss diabetes-related topics to make sure it’s not different
Blood glucose are not “good” or “bad” – merely information to determine the student’s needs
Praise your students for completing diabetes tasks
It’s not easy or fun – the more you praise and reinforce positive diabetes care habits, the better they will do
Some tips when interacting with your student’s with diabetes include:
Talk about normal, regular, every day things before talking about diabetes
Pay attention to your tone of voice when you discuss diabetes-related topics to make sure it’s not different
Blood glucose are not “good” or “bad” – merely information to determine the student’s needs
Praise your students for completing diabetes tasks
It’s not easy or fun – the more you praise and reinforce positive diabetes care habits, the better they will do

11. Module 13 Pre – and Post – Tests:
Psychosocial Aspects
This tool may be freely duplicated and distributed for training purposes

12. The age at which students should be able to self-manage their diabetes varies for each child.
True
False
Pre-schoolers and toddlers are usually able to choose their injection sites.
Diabetes should be the first thing that is discussed with the child.

13. American Diabetes Association
Where to Get More Information
American Diabetes Association
DIABETES