1. Medical Management for Children with Diabetes
2015 Safe at School:
Medical Management for Children with Diabetes

2. Objectives
At the end of this learning session participants will be able to:
Describe how the anaphylaxis law affects treatment students with diabetes will receive
State the importance of diabetes self-management
Discuss treatment for hyperglycemia
Discuss treatment for hypoglycemia

3. Anaphylaxis Law Food items containing peanuts removed
Supplies needed for school
Snack
Treatment

4. Additional Changes Diabetes Medical Management Plan Date Diagnosis CGM
Type 1 vs Type 2
CGM
Treatment
Hyperglycemia
Hypoglycemia
Insulin orders
Type 2

5. TREATMENT AND INTERVENTION FORM
MANAGEMENT PLAN
(1)
Date of Plan: __________
DIABETES MEDICAL MANAGEMENT PLAN
Expiration date: ______________
(2)
 Insulin Dependent Diabetes
DIAGNOSIS:  Type 1 Type 2  Other Diabetes ________________________
(3)
Continuous Glucose Monitor (CGM):  Yes  No
Brand/Model: _______________________: CGM may be worn for daily or occasionally
Note: Confirm CGM results with blood glucose meter check before taking action on sensor glucose level. No medical treatment should be rendered based on CGM result only. If student has symptoms or signs of hypoglycemia, check fingertip blood glucose level regardless of CGM.
TREATMENT AND INTERVENTION FORM
Student’s Name: _______________________________________________________ Date of Birth: _________________
Begin Treatment_____________________________________ Stop Treatment______________________________
Date Date
DO NOT DISCARD THIS FORM UNTIL THE STOP DATE AS LISTED ABOVE

6. Diabetes Self-Management

7. Diabetes Self-Management
Importance:
Gain knowledge
Learn and practice skills
Modify behavior
Successfully self-manage
Diabetes self-management education is also known as diabetes self-management training. DSME/DSMT is a collaborative process. People with diabetes or at risk for diabetes work with their healthcare providers and other health care professionals learning about the diabetes process. Hopefully, the collaborative interaction will equip patients and families to:
Gain the knowledge to understand the disease
Introduce them to new skills such as monitoring blood sugars, check urine/blood ketones, count carbs, inject insulin, &/or receive pump training
Modify behaviors by changing lifestyle. For example,
The knowledge can empower families to successfully self-manage diabetes and its related conditions.
This process is on-going for the students and Y O U, as school nurses, play a major part in reinforcing their education.

8. Diabetes Self-Management
Treatment and Intervention Form
Self-care skills
Blood glucose testing NA Ind supv total kept
Ketones testing NA Ind supv total kept
Glucose/gel NA Ind supv total kept
Count carbohydrates NA Ind supv total
Calculate insulin dose NA Ind supv total
Give insulin by injection NA Ind supv total kept
Give insulin by pump NA Ind supv total kept
Change infusion set NA Ind supv total kept

9. Diabetes Self-Management
Treatment and Intervention Form
Blood glucose monitoring
When to check:
Before meals
Anytime s/s high/low blood glucose
Urine Ketones testing
Greater than 300
Student sick and /or vomiting
Glucose tablet/gel
When to use:
Treat hypoglycemia

10. Diabetes Self-Management
Definition:
Ind = independent self-management
Supv= self-management with nurse supervision
Total = total care by nurse
Kept = kept on person
NA = does not apply to my child; my child is not doing or using this

11. Insulin Orders Review Original orders from state COA orders Pump
Correction factor + carbohydrate ratio
Correction factor + fixed
Sliding scale + fixed
Sliding scale + carbohydrate ratio

12. Insulin Orders
Original Form

13. Insulin Orders
Pump Therapy

14. Insulin Orders
Correction + ratio

15. Insulin Orders
Sliding Scale + Fixed

16. Insulin Orders
Insulin Orders

17. Treatment:
Hyperglycemia
Hypoglycemia

18. Hyperglycemia
Injections

19. Hyperglycemia
Pump Therapy

20. Case Studies

21. Hypoglycemia
Injections

22. Hypoglycemia
Pump Therapy

23. Case Studies

24. Type 2 Student has Type 2 Diabetes
Able to control their blood sugar levels by managing their weight, eating healthy meals and getting plenty of exercise. However, if not enough…may have been medications that are taken by mouth and/or by injections. These medications are not administered during school hours.
At times this student may have high blood sugars. High blood sugar (hyperglycemia) in people with diabetes can often cause unusual thirst and the need for frequent urination. If this occurs, he/she will probably need to go to the restroom more often than usual. Please allow him/her the freedom they need on these occasions to do so.
A balanced intake of milk products, fruits, vegetables, breads and meats is the meal plan Concentrated sweets (candy, sweet rolls, cake, chocolate milk, etc.) should be avoided. Students with diabetes may eat anything on breakfast or lunch trays except desserts and drinks containing sugar. We have encouraged him/her to substitute fresh fruit or fruit packed in natural juice (not syrup) for their dessert.
Additionally, we have instructed this student to test his/her blood sugar any time he/she is not feeling well. If the student is required to test his/her blood sugar a treatment intervention form will be sent to the school.
This is considered a minimal standard for safety in the school setting and is covered under the Americans with Disabilities Act.

25. How Can You Assist Children’s (COA)
All communication to COA must contain name of student and date of birth
Make sure you send glucose readings home. Caregivers need this information when communicating with COA.
It is ok to fax the readings from school; however, we need all readings
We have a revised fax sheet for families needing assisting

26. Questions

27. References:
AADE (2011). Diabetes Self-Management. The Art and Science of Disease Self-Management Education Desk Reference;(2)
NDEP (2010). Helping the Student with Diabetes Succeed. A Guide for School Personnel.
Pediatrics (2012). Policy statement- Guidance for the Administration of Medication in School. Retrieved from