1. Diabetes Information for Schools
Reviewed: July 2015
Introduction
Explain that the talk will last approximately 30 minutes, there will be an opportunity for questions at the end of the session & an evaluation to complete which will be used when planning similar sessions

2. Diabetes Awareness
The aim of this talk is to raise awareness of diabetes and the management of diabetes at school.
What is diabetes ?
Types of Diabetes
Management of diabetes at school

3. Roles and responsibilities
Parents to liaise with school re child’s needs during school day.
Parent will discuss and agrees the individual healthcare plan for their child with school staff and paediatric diabetes specialist nurse (PDSN)
PDSN will complete training for school staff as required. ( this can take up to 5 visits).
School nurse/community nurse can provide awareness talks for all school staff

4. Diabetes
Affects 1 in 300 school age children and is a chronic condition.
It occurs when the amount of glucose (sugar) in the blood is too high because the body is not able to use it properly.
There are many different types of Diabetes but most commonly : Type1 and Type 2.

5. Early signs of Diabetes
Thirst
Toilet (frequency)
Thin (weight loss)
Tiredness and lack of concentration
( may experience blurred vision)
* N.B teachers can often identify the signs that a child may be developing diabetes.

6. Type 1 Diabetes
Auto immune condition causing the destruction of insulin producing cells in the pancreas.
Without insulin the child’s body cannot use glucose and the blood glucose levels rise.
Most common type in children but not due to poor diet or lack of exercise
Treated with subcutaneous insulin, careful monitoring, and promotion of healthy eating.

7. Management of Type 1 Diabetes
Diabetes cannot be cured but it can be treated effectively
Managed with a combination of insulin, healthy eating & frequent blood glucose monitoring.
Insulin is destroyed by the digestive juices of the stomach so must be given by injection.
Insulin lowers blood glucose level
Insulin doses need to be balanced with food intake
Aim is to keep blood glucose levels close to normal range 4 – 7mmol/l

8. Type 2 Diabetes Body still makes some insulin but is insulin resistant
Usually occurs in people over 40
Risk increased in children and young people who are overweight.
Treated by:
Healthy eating & exercise , +/- tablets
May require Insulin injections also.

9. Normal Regulation of Blood Glucose

10. Blood Glucose Testing Children should test blood glucose levels
regularly during school hours.
Young children may need assistance to test their blood glucose level.
N.B child’s hands must be washed prior to testing for accuracy.
Involves pricking finger with a special device
Blood placed on a reagent strip inserted in a meter, which gives result in 5 sec.
Blood Glucose Testing
People with diabetes can check the level of glucose in their blood by means of a simple blood test. Most pupils do this on a regular basis. Pupils may need to do this at school, especially before or after physical activity, or if they feel their blood glucose level is falling too low (below 4 mmol/L) or climbing too high. The aim is to try to maintain blood glucose between 4-10 mmol. Only some pupils will require to test their blood glucose levels in school. It involves pricking finger with a special device, blood is placed on a reagent strip & read by an electronic device. Most pupils will be able to do this unsupervised, Parents/carers should discuss details with the school.Some pupils will require assistance, training for staff will be provided where necessary.

11. Blood glucose testing cont’d
Parent/carers should discuss their child’s needs during school hours.
Training will be provided by the PDSN for school staff who volunteer to assist children as needed.
Parents/carers are responsible for the provision and disposal of all equipment including sharps boxes.

12. Blood glucose levels Normal blood glucose range : 4 - 7mmol/l
Hypoglycaemia is a blood glucose level below 4 mmols/l and requires immediate action
Hyperglycaemia is 14mmol/l and above ( too high)
Prolonged hyperglycaemia increases the risk of complications effecting long term health.

13. CGM – Continuous Glucose Monitoring
Increasingly popular method of checking interstitial glucose levels
Examples include Libre and Dexcom

14. Libre
A sensor is worn on the back of the upper arm. It enables monitoring between meals by scanning reader over sensor and reading will appear on screen

15. Scanning the Libre sensor should not replace finger prick blood sugar checks at mealtimes when insulin is being administered.
A finger prick blood sugar should be carried out if Libre reading is either below 5, above 12 or trend arrow is straight up or down, to ensure accuracy.

16. Insulin delivery(injections)
Two/three injections daily – not in school or
4-5 injections daily – (1 before lunch)
Injections usually given with pen device
Parents/carers arrange with school safe storage of insulin pen and a private area to inject.
Children who are unable to self inject will require assistance at school.
Training will be provided by the PDSN for volunteers who wish to help with this.
Insulin Usage
Children may be on twice daily injections of insulin or may need 3 to 4 injections daily. In which case one of the injections will need to be taken in school. If a child needs injections in school the child should be able to administer the insulin unsupervised.However some children will nt be able to self administer insulin, training will be provided to designated staff on administration of insulin where necessary.Most insulin injections are now given with a pen device. Parents/carers must arrange with the school where the insulin will be kept and it must be ensured that the child is given a private place to administer the injection.
Insulin Pumps deliver rapid or short acting insulin continuously 24 hours a day through a catheter under the skin. This keeps the blood sugar levels controlled between meals and at night. Extra insulin can be given before meals or if the blood sugar rises, this is controlled by by buttons on the pump.

17. Where injections are given:
Environment – clean, private area (not toilets)
Injection sites recommended are highlighted in the diagram as below and a new site used each time

18. Insulin delivery (pumps)
Increasingly popular method of insulin delivery, especially in younger age group.
Delivers insulin continuously through a cannula under the skin
Blood glucose levels must be tested before any food is taken
Boluses of insulin are delivered via buttons on the pump ( some children will need help with this)
Parents and children need to be accurately counting carbohydrates for this method to be effective.
Individualised training for school will be given as necessary.

19. Sharps Disposal
Parents responsibility to provide and dispose of sharps boxes
If child able , allow to remove own used pen needle and dispose in sharps box
If a needle stick injury occurs immediately bleed the wound, then place under cold running water for 5 minutes and seek medical advice.

20. Dietary advice
We promote healthy eating as recommended for whole of the population
Low in sugar & fat & high in fibre
Meals & snacks taken at regular intervals
Most are trained to count carbohydrates to give appropriate insulin doses.
Diabetic products are not recommended

21. Meal times
Younger children will need one to one supervision at break and lunch.
School dinners- parents responsible for calculating the carbohydrate content of foods.
Some pupils may be permitted access to the top of the queue at lunch time.

22. Hypoglycaemia (Hypo)
Hypoglycaemia is the most common complication in diabetes
It occurs when the bloods glucose falls below 4mmols/l
The symptoms vary from child to child and are documented within their individual health care plan
Older children generally recognise their hypo and will take appropriate action themselves
The very young or newly diagnosed will require assistance

23. Hypoglycaemic treatment kit
Each pupil should have an individual healthcare plan & hypoglycaemic kit which should be kept in school
Parents/carers are responsible for
Providing the hypoglycaemic kit, ensuring it is correctly labelled
Ensuring all medication and food supplies are within expiry dates
Replacing any used medication and food supplies
Ensuring any changes in medication or regimen are notified promptly
Ensuring any changes in contact details including emergency telephone numbers are notified promptly

24. Hypoglycaemia (causes)
Too much insulin
Not enough food eaten
Delayed food
Too much or too intense exercise
Unscheduled exercise
Hot weather
Alcohol
There may be no obvious cause

25. Mild Hypoglycaemia symptoms
Hunger
Shakiness
Weakness
Paleness
Personality change
Dizziness
Sweating
Drowsiness
Anxiety
Irritability
Symptoms will be different for each individual pupil

26. Management of Mild Hypoglycaemia
Give a fast acting sugar (10- 15g CHO)
Lucozade OR
Coke (non diet)
Glucose tablets
Fruit pastilles , or jelly babies
fruit juice
Remain with pupil until fully recovered usually 10 – 15 minutes - retest blood glucose (B.G)
Repeat treatment above if symptoms persist
Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or snack is not due within 30 minutes
Return to class if symptoms resolve and continue with normal activities including snacks and meals
Document hypo and inform parents/carers as previously agreed .
Never use chocolate to treat a hypo, as it does not release the sugar quickly

27. Moderate Hypoglycaemia symptoms
Behaviour change
Headache
Blurred vision
Slurred speech
Poor co-ordination
Confusion
Symptoms will be different for each individual pupil, these are recorded on their healthcare plan.

28. Management of Moderate Hypoglycaemia
If the pupil is cooperative treat as per mild hypoglycaemia
If uncooperative but able to swallow
Give GlucoGel as directed in healthcare plan.
Twist off cap to break the seal
Give one tube of glucogel into the mouth between the gum and cheek in small amounts and massage cheek
DO NOT GIVE IF PUPIL CANNOT SWALLOW OR HAS “PASSED OUT”
Remain with pupil until fully recovered usually 10 – 15 minutes (retest)
Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or snack is not due within 30 minutes
Return to class if symptoms resolve and continue with normal activities including snacks and meal
Inform parents/carers of hypoglycaemic episode
If the child deteriorates becoming drowsy & unable to swallow treat as per severe hypoglycaemia

29. Severe Hypoglycaemia Unconscious Unresponsive
Seizure with possible incontinence
Rarely occurs at school

30. Management of Severe Hypoglycaemia
Do not give anything to eat or drink
Place in recovery position if possible
Remain with pupil
Call paramedic ambulance
State hypoglycaemic episode
Give name & location of school
State where ambulance will be met
Assign someone to meet ambulance
Ensure pupil is accompanied in ambulance by a responsible adult e.g. parent/teacher
Advise ambulance crew of treatment administered
Give all used medication to ambulance crew
Contact parents/carers ASAP

31. Summary of progression of hypoglycaemia
Mild hypoglycaemia goes untreated
Moderate hypoglycaemia goes untreated
Severe hypoglycaemia goes untreated
Can result in unconsciousness & coma
Promptness of diagnosis in early stages is essential in preventing progression of hypoglycaemia

32. Recovery Position

33. Hyperglycaemia Blood glucose level above 14mmol/l
Pupil may feel thirsty
Will need the toilet more frequently
May complain of a sore tummy or head and feel lethargic
Contact the parent for further advice
May become unwell if not managed as agreed in healthcare plan

34. Exercise
All pupils should be able to participate fully in all activities
Exercise uses up glucose
Exercise will not always drop blood glucose at the time of activity due to adrenaline.
Effects of exercise can last in the body for up to 18 – 24hrs depending on duration and intensity.
Blood glucose will fall if
Not enough glucose has been taken prior to exercise
Too much energy is used during exercise and not replaced.
This may lead to hypoglycaemia

35. Preparation for Exercise
Before exercise blood glucose levels should be tested and their hypo kit should be brought with the child.
A small snack may need to be taken before, during or after activity
e.g. Mini chocolate bar or Cereal bar or 2 plain biscuits
N.B. Some pupils will adjust their insulin prior to sport and may not need a snack
Hypo kit should include
Glucose tablets or
Sugary drink
Following exercise more food may need to be taken depending on the level of exercise, duration and intensity.

36. Myths
A diabetic diet does not exist (just healthy eating for general population advised)
Diabetes is not caused by eating too many sweets
No one just has “A touch of diabetes”
No one grows out of diabetes

37. School Trips – Day Trips
Reasonable steps should be taken by schools to encourage pupils with medical needs to participate in school trips wherever safety permits, for further guidance refer to Supporting Pupils With Medication Needs DOE & DHSSPSNI 2007.
Take hypoglycaemic kit & action plan
All diabetes medication and equipment required must taken
Food for journey in case of delays and contact numbers
Mobile phone can be considered.

38. School Trips – Overnight Stays
Most pupils should be able to go on school trips provided reasonable steps are taken
Parents/carers/school staff should contact Paediatric Diabetes Nurse Specialist at least a month prior to trip to discuss supervision and plan of care whilst away.
Take hypoglycaemic kit & healthcare plan
Food for journey in case of delays
Insulin injections/ pump supplies
Blood glucose monitoring equipment
Take double supplies which should be carried separately in case of lost luggage etc.
Mobile phone must be taken

39. Examinations
Emotional stress and anxiety can cause fluctuations in blood glucose levels
Children/young people perform at their best when diabetes is well controlled
Blood glucose should be checked before each exam
Hypo treatment must be available
Letter can be requested from their consultant for special consideration in case of hypoglycaemic episode.

40. Useful links:
Diabetes UK Children with Type1diabetes at school :what all staff need to know
DHPPS/DENI(2008) Supporting pupils with medication needs
RCN(2013) Supporting children and young people with diabetes
What Diabetes care to Expect in schools . (2015)compiled by DUK, PHA, Education and library boards NI