1. The Student with Diabetes

2. 1 Agenda Agenda  Types of diabetes  Management  Hypoglycemia  Hyperglycemia  Responsibilities

3. 2 What is Diabetes What is Diabetes  Much of the food eaten becomes a sugar called glucose  The pancreas makes a hormone called insulin  Insulin allows the body to use the glucose for energy

4. 3 Types of Diabetes Types of Diabetes Type 1  Auto-immune illness Pancreas not producing enough insulin Requires insulin injections Must test blood glucose (BG) at school  Usually diagnosed at a younger age  Chronic condition  Cannot be prevented Type 2  Most common type of diabetes  Can often control with diet, exercise or pills  May also take insulin  Usually diagnosed at an older age – infrequent in school age child  May not need to test BG sugars at school

5. 4 Each Student with Diabetes is an Individual – Individual Plan of Care Each Student with Diabetes is an Individual – Individual Plan of Care

6. 5 General Diabetes Management Goals General Diabetes Management Goals  Keep student safe from extreme lows and highs  Balance of food choices, exercise, & insulin  Aim for majority of blood glucose levels in target – this is challenging  Normal school routines for student  Optimal learning at school  Promote normal growth & development

7. 6 Target Blood Glucose (BG) Range Target Blood Glucose (BG) Range < 5 years: 6-12 range 5-10 years old: 4-10 range >10 years: 4-7 range Hypoglycemia < 4 (must treat) Hyperglycemia > 15 (additional information needed)

8. 7 Blood Glucose (BG) Testing Blood Glucose (BG) Testing  Tool to assess BG (meter)  Done routinely before meals and if a low is suspected  Must treat immediately if < 4  Avoid placing “judgment value” i.e. good or bad on high or low blood glucose readings

9. 8 Insulin Delivery Systems Insulin Delivery Systems  Most children get insulin before breakfast, supper and bedtime  Some children get insulin at lunch  Syringe  Insulin pen  Pump  Insulin Pump provides an almost continuous flow of insulin

10. 9 Insulin Action – around the clock coverage Insulin Action – around the clock coverage

11. 10 Some Children Wear Insulin Pumps Some Children Wear Insulin Pumps

12. 11 School Nurse Considerations School Nurse Considerations  Assess the level of assistance the student requires  Support with the development of independence  School Nurse Role  Assist with BG testing if needed  Assist with insulin administration via pen or syringe  Assist with entering BG and carb amount into pump for pump bolus  Ideal is to bolus/give insulin pre food  Hypoglycemia: identify and treat  Prompt contact with care givers if concerns

13. 12 Age Appropriate Expectations Age Appropriate Expectations  Pre-Schooler  washes hands before testing  offers finger to be picked  School Age  chose injection site  identifies food groups  tests independently - caregiver supervises  younger child may need more direction  Teen  independent with insulin, food choices, testing  BUT - caregiver still involved to monitor and support

14. 13 Nutrition Basics Nutrition Basics  Main nutrient that increases BG is carbohydrate grains, fruits, milk, sugars  Protein & Fat do not increase BG  Nutritious choices are encouraged, not always made!  No Forbidden Foods  Normalize with same eating times /routines/ food choices as other students  Allow child to eat all food as provided by caregivers

15. 14 Special Occasions at School Special Occasions at School  Children with diabetes can and should participate in all school activities  With advanced planning, diabetes can be managed around all special events and treats  If uncertain how to proceed, contact caregiver for management advice or send the treat home

16. 15 Exercise Exercise  Children with diabetes can be involved in all school activities with some additional precautions  Exercise can lower BG Consider checking BG levels before, during and after activity May need additional glucose or carbohydrate  Important for school staff to be aware of impact of exercise on diabetes  Medical Alert Bracelet

17. 16 Hypoglycemia Low Blood Glucose Hypoglycemia Low Blood Glucose  Treat every BG less than 4  Causes Too much insulin Too little Food  Delayed, inadequate or skipped meal or snack  Extra exercise without extra food or a decrease in insulin

18. 17 Hypoglycemia Symptoms Hypoglycemia Symptoms  Shaking  Headache  Stomach ache  Pale skin  Hunger  Fatigue  Irritability  Blurred vision  Slurred speech  Decreased level of consciousness Important to understand students individual symptoms If unsure if student is low, do a BG test. If unable to test, always treat. Occurrence of a severe low is rare in the school setting

19. 18 Hypoglycemia Treatment for Mild or Moderate Hypoglycemia Hypoglycemia Treatment for Mild or Moderate Hypoglycemia  Junior juice (125 ml)  3-4 dex glucose tablets  2 rolls of rockets  2 tsp. honey  3 tsp. sugar  1/3 cup regular soda

20. 19 Hyperglycemia High Blood Glucose Hyperglycemia High Blood Glucose Above 15 is considered warning of hyperglycemia  Causes Too much food Too little insulin Inaccurate BG test result Decreased activity Illness/infection Stress If BG is > 15mmol/L and child is feeling unwell (flu like symptoms) notify caregivers.

21. 20 Hyperglycemia Hyperglycemia Mild - Moderate  Symptoms  Increased urination  Increased thirst  Blurry vision  Increased hunger  Recommendations Fluids and washroom access Inform parent Contact parent if unwell Severe  Symptoms  Fruity breath  Vomiting  Stomach cramps or pain  Extreme weakness  Sleepiness  Difficulty breathing  Coma  Medical emergency  Contact parent and/or 911

22. 21 Hyperglycemia Management  If the BG > 15mmol and the child feels unwell with flu like symptoms, contact the caregivers immediately  If the BG is > 15mmol and the child is well (able to eat, drink, and be involved in school routines)  contact the caregivers if part of plan of care  continue with the usual school activities of meals and snacks as provided by caregivers  continue with usual activity plan (no additional activity required)  encourage water intake if child is agreeable  expect increased use of the washroom  document BG and any concerns in agenda or planner

23. 22 Emergency Situations Emergency Situations If at any time a student experiences a decreased level of consciousness, call 911

24. 23 Psychosocial Aspects Psychosocial Aspects  Challenging regimen with limitations & restrictions  How you can help treat diabetes matter-of-factly BG variability is common – diabetes is hard to control appreciate no one makes ideal food choices at all times provide encouragement & understanding accommodate diabetes management within classroom routines as much as possible

25. 24 School’s Responsibility School’s Responsibility  Learn about diabetes  Ensure all meals and snacks, as provided by parents, are completed on time  Know symptoms and management of hypo/ hyperglycemia  Communicate regularly with parents  Provide space for testing and storage of diabetes supplies in the classroom  Know when to contact parents/guardians  Educate other students  Consider best location for diabetes care – may prefer privacy  Update annually using Trillium website: http://www.trilliumhealthcentre.org/programs_services/womens_chil drens_services/childrensHealth/familyCareCentre/paediatricDiabetes Clinic.html

26. 25 Student’s Responsibility Student’s Responsibility  Notify teacher when feeling unwell  Accurately document BG in planner/agenda  Take sharps home for safe disposal  Eat all food provided by parents in a timely manner  Educate other students  Participate in all school activities  Tell adults - parents, teacher – when supplies are low  Wear medic alert

27. 26 Caregiver’s Responsibilities Caregiver’s Responsibilities  Establish positive relationship with school  Take sharps home for safe disposal  Provide nutritious lunch and snack choices  Ensure extra supplies are stored at school  Communicate as needed with school and educate as required  Advocate for child’s best care  Update school staff each year: http://www.trilliumhealthcentre.org/programs_services/wo mens_childrens_services/childrensHealth/familyCareCentre/ paediatricDiabetesClinic.html

28. 27 Diabetes Websites Diabetes Websites For additional information on Type 1 diabetes: Canadian Diabetes Association www.diabetes.ca Juvenile Diabetes Research Foundation www.jdrf.ca Trillium Health Centre //www.trilliumhealthcentre.org/programs_services /womens_childrens_services/childrensHealth/fa milyCareCentre/paediatricDiabetesClinic.html