1. Diabetes Care Tasks at School: What Key Personnel Need To Know
CHILD care
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
All staff members should have basic knowledge of diabetes and know who to contact for help.
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 Child Care.

3. Learning Objectives Participants will be able to understand:
Basics of caring for a child with diabetes at daycare
Hypoglycemia and Hyperglycemia
Diabetes care tools and resources
Participants will be able to understand:
Basics of caring for a child with diabetes
Hypoglycemia and hyperglycemia
Diabetes care tools and resources
In addition to this training, we recommend caregivers to take the following trainings, available online at
Introduction to Diabetes
Diabetes Basics
Hypoglycemia
Hyperglycemia
Blood Monitoring
Continuous Glucose Monitoring
Glucagon Administration
Insulin Basics
All of these can prepare you to learn more about diabetes, but the Diabetes Care Plan is determined by the parents/guardians of the child based on the individual child’s needs and Diabetes Medical Management Plan.

4. Special Considerations When Caring for a Child with Diabetes
Children, especially young children, are totally dependent on adults.
Depending on age and development, some have limited or no communication skills.
With proper planning and glucose management, a child with diabetes can and should be allowed to participate in ANY activity.
Children, especially young children, are totally dependent on adults. Depending on age and development, some have limited or no communication skills but with proper planning and glucose management, a child with diabetes can and should be allowed to participate in ANY activity. However, treat children with diabetes the same as other children, except to meet their diabetes needs.
Prior to caring for a child with diabetes, it is vital that the Caregiver has received training on:
Blood glucose management
Insulin administration
Recognizing symptoms of high and low glucose levels
Specific diabetes care plans, directly from the child’s guardians/parents

5. Diabetes Management Constant Juggling – 24/7 Glucose Raising
- Food - Not enough insulin or carbs don’t match insulin provided
- Illness, stress, injury - Side effects from other medications (steroids)
- Too much insulin - Carbohydrates don’t match insulin given or didn’t finish all carbohydrates after providing insulin
- Exercise or activity *
Glucose Raising
Glucose Lowering
Maintaining blood glucose control is a juggling act, 24 hours a day, 7 days a week.
Many variables affect blood glucose.
The key to optimal diabetes control is a careful balance or juggling of food, physical activity, and insulin and/or oral medication.
As a general rule:
Insulin/oral medication and physical activity makes blood glucose levels go down.
Food makes blood glucose levels go up.
Several other factors, such as stress, illness or injury, also can affect blood glucose levels.
* Physical activity generally lowers blood glucose. However, certain activities may raise blood glucose for some students.

6. Child Care Diabetes Medical Management Plan (DMMP)
Developed with input from the parent/guardian
Based on the DMMP or “medical/physician’s orders”
Communicates the diabetes management strategies for the student in the daycare setting
Child Care DMMP developed by the health care provider with input from the parent/guardian. The DMMP documents and communicates the individual student’s needs and the staff management strategies for the child in the daycare setting and is based on the medical orders found in the Diabetes Medical Management Plan. Many providers have their own health care plans and forms.

7. Diabetes Care Tasks by Child Care Staff
Before food intake and physical activity and when low or high blood glucose is suspected. Equipment includes blood glucose meter, lancet, lancing device, test strips, CGM (if used).
Blood Glucose Monitoring
Before or after food intake and to treat high blood glucose. Equipment includes insulin, delivery device (pump, pen, syringe).
Insulin Administration
Snacks and meals provided and/or monitored to ensure food consumption is in accordance with insulin dosing. Equipment includes food, carbohydrate information.
Food Intake Scheduling and Monitoring
Awareness that unusual behaviors after physical activity or insulin may signify hypoglycemia. Equipment includes quick-acting carbohydrates and glucagon.
Hypoglycemia Treatment
Awareness that increased urination or drinking may signify hyperglycemia. Equipment includes water or other non-carbohydrate-containing liquid, insulin.
Hyperglycemia Treatment
Check ketones if repeated blood glucose tests show above target range or if the child is ill. Equipment includes urine or blood ketone strips, ketone monitor.
Ketone Monitoring
Diabetes care tasks prescribed by the DMMP include:
Blood glucose monitoring, including target glucose, the frequency and circumstances of checking and the use of CGM systems
Insulin administration, including doses, timing, insulin storage and the use of the prescribed insulin delivery device
Symptoms and treatment of hypoglycemia, including glucagon
Symptoms and treatment of hyperglycemia, including ketone checks
A sample DMMP for the child care setting may be found at

8. Mild to Moderate Symptoms
Hypoglycemia: Possible Signs and Symptoms
Mild to Moderate Symptoms
Hunger Sleepiness
Shakiness Changed behavior
Weakness Sweating
Paleness Anxiety
Dizzy or lightheaded Dilated pupils
Increased heart rate Restlessness
Yawning Confusion
Irritability/frustration Sudden crying
Extreme tiredness/fatigue
Severe Symptoms
Inability to eat or drink
Unconscious
Unresponsive
Seizure activity or convulsions
(jerking movements)
Preventing and treating low blood glucose is one of the biggest responsibilities as a caregiver.
When caring for children with diabetes you need to be familiar with both signs and treatment for hypoglycemia and hyperglycemia. Each individual shows signs of lows at different blood glucose levels. Discuss the typical signs of lows with the parents and review the treatment in their care plan carefully. When applicable, ask the child if they know their symptoms of low blood sugars.
Hypoglycemia requires immediate attention to prevent a severe low blood sugar reaction that can lead to the child passing out, having a seizure or death.
Hypoglycemia is usually easily treated with a fast acting carbohydrate such as juice.
It is important to treat immediately, so if you notice any changes, always check blood glucose to be sure.
The symptoms of mild to moderate hypoglycemia are the first alert that the body is in a state of sugar deficiency. Mild to moderate hypoglycemia can usually be treated easily and effectively. Most episodes of hypoglycemia that will occur are of the “mild” type.
However, if not treated promptly a mild hypoglycemic reaction can quickly progress to a severe state or condition which may be characterized by severe cognitive impairment and will require assistance in treatment:
The important thing to remember is that early recognition and intervention is the best strategy to prevent progression to more severe symptoms.
Link to Hypoglycemia module.

9. Severe Low Blood Glucose
If a child should become unconscious, or can’t eat, drink or swallow…
1. Glucagon Emergency Kit should be given without delay
2. Parents should be immediately notified, call 911
Link to Glucagon

10. Hyperglycemia: Possible Signs and Symptoms
Mild Symptoms
Lack of concentration Thirst
Frequent urination Flushing of the skin
Sweet, fruity breath Blurred vision
Weight loss Increased hunger
Stomach pains Fatigue/sleepiness
Moderate Symptoms
Dry mouth Vomiting
Stomach cramps Nausea
Severe Symptoms
Labored breathing Confusion
Profound weakness Unconscious
High blood glucose can be caused by a number of things, including: too little insulin, too much food, not enough exercise, even illness and stress.
Refer to the care plan to determine what is the typical blood glucose range for the child and work with the parents to have a plan for handling a high blood glucose reading.
The important thing to remember is that intervention at any of these levels will prevent progression to more severe symptoms.
Link to Hyperglycemia module.

11. Administering Insulin
Many children require rapid acting insulin before meals and snacks; timing should be included in the Diabetes Care Plan
Note, hypoglycemia can occur if meal or snack is delayed for than 15 minutes after insulin injection or insulin pump bolus
The carbohydrate amounts need to be calculated or the child will need help in choosing foods that fit their meal plan
It is important that the child eats all the food they said they were going to eat to prevent a low blood sugar since the insulin was determined by the prescribed amount of food
TALKING POINTS
Insulin dose will vary, depending upon:
blood glucose readings
food availability/preference
activity level
age and body weight
See the child's Diabetes Care Plan for specific instructions.
Link to Insulin Basics

12. Parent/Guardian should be called if a child has:
High Alert Situations
Parent/Guardian should be called if a child has:
Severe low blood glucose
Vomiting, positive ketones
Refusing to eat
Refusing to check blood glucose
Low blood glucose has been treated but is not coming up
High blood glucose has been treated but is not coming down
Parent/guardian should be called during certain situations. These high alert circumstances include:
Severe low blood glucose
Vomiting, positive ketones
Refusing to eat
Refusing to check blood glucose
Refusing to take insulin
High blood glucose has been treated, but is not down
Low blood glucose has been treated but it is not going up.
Communication is an important piece of the Diabetes Care Plan. High alert situations are not anticipated frequently but routine communication with the parent/guardian is still important. Regularly communicate blood glucose results, insulin doses provided, symptoms and treatment of hypo- and hyper-glycemia, food intake, and physical acting using a logbook, electronic application or other method provided by the parent/guardian.

13. Key Principles Diabetes should not be a reason to refuse enrollment
Critical components for success include:
Written care plans
Provision of care by child care staff
Basic training for all staff in a child care setting
Advanced training for a small group of child care staff
Instruction should include demonstration of the care tasks and a plan for ongoing training
Participation in diabetes care allowed for capable children
Key points.
Child care should not be refused based on diabetes or the need for diabetes care. The parent/guardian should share strategies for overcoming challenges; education and training is available to address Center’s concerns. The following are critical for successful implementation of a Diabetes Care Plan.
Written care plans
Provision of care by child care staff
Basic and advanced training for identified care staff. Instruction should include demonstration of the care tasks and a plan for ongoing training.
Child participation in diabetes care is recommended for capable children

14. Module 14 Pre – and Post – Tests:
title goes here
This tool may be freely duplicated and distributed for training purposes

15. Younger children with diabetes are usually completely dependent upon their care giver for diabetes care.
True
False
Which diabetes care task cannot be performed by child care staff?
Insulin administration
Blood glucose monitoring
Glucagon administration
Carbohydrate counting
None of the above
Under which circumstances should a parent/guardian be notified?
Severe low blood glucose
Vomiting, positive ketones
Refusing to eat
Refusing to check blood glucose
Refusing to take insulin
High blood glucose has been treated, but is not down
Low blood glucose has been treated but it is not going up.
All of the above

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