1. Diabetes 101 For School Employees

2. Purpose: To ensure a safe, therapeutic learning environment for the student with diabetes.* *and to comply with state law

3. Diabetes is a chronic illness caused when the pancreas doesn’t make any or enough insulin. (Type I) Type II Diabetes Insulin is produced by the pancreas but the body’s cells resist insulin function.

4. Causes of Diabetes Inherited (genetic) Autoimmune (self allergy) Environmental (viral/chemical )

5. You don’t outgrow it! Diabetes is not contagious!

6. This is a life- threatening health condition !

7. Glucose = Sugar

8. Normal Insulin Function Food we eat…. …is digested by the stomach and converted to glucose…

9. … glucose is absorbed by the intestine into the blood. The pancreas makes insulin and releases it into the blood stream.

10. Insulin is the key… …that “unlocks” the body’s cells so glucose can enter the cells and be burned for energy. Without insulin,the body’s cells can’t burn glucose for energy and sugar accumulates in the blood.

11. Management of Diabetes Exercise Insulin Diet Normal Blood sugar Desirable blood sugar for children with diabetes: 70-150mg/dl

12. Exercise Too much food… Diet Blood sugar Insulin …blood sugar rises.

13. Too much exercise… Diet Insulin Exercise …blood sugar falls Blood sugar falls

14. Too much insulin….. Diet Exercise Blood sugar falls Insulin …..blood sugar falls.

15. Insulin Hormone Taken by multiple injections throughout the day or by a pump Lowers blood sugar Many different types

16. Types of Insulin Rapid acting (Humalog) onset 15 minutes peaks 30-90 minutes Intermediate (NPH, Lente) onset 1-4 hours peaks 6-12 hours duration about 3.5 hrsduration 12-24 hours Short acting (Regular) onset 30-60 minutes peaks 2-4 hours duration 4-8 hours Long Acting (Ultra Lente) onset 4-6 hours peaks 8-15 hours duration 18-24 hours Long Acting (Lantus) given 1x/day Slower, prolonged absorption No peak

17. Insulin Additional points All insulin lowers blood sugar but peaks (has its maximum effect) at different times. Rapid acting insulin starts to work very quickly and leaves the body quickly. Meals must be eaten immediately after injecting this insulin. Short acting is ideally injected 30 minutes before eating. Most students are on a “sliding scale” that allows the dosage of rapid-acting or short acting insulin to be adjusted according to blood sugar level and food intake.

18. Meal Planning Student may need 2-3 snacks/day. Student may be counting carbohydrates eaten to calculate insulin dosage. Sugar is ok and small or calculated amounts are acceptable in a diabetes meal plan.

19. Carbohydrates Most important aspect of the meal plan Include bread and starches, and fruit Main source of blood glucose – approx. 90- 100% enters the blood stream as glucose 15 min.-2 hours after eating

20. Proteins Approx. 50-60% of dietary protein is converted to glucose and released into the blood stream 2-5 hours after meal Includes meat, fish, poultry, eggs, peanut butter, cheese, and meat alternatives Adds ‘staying power’ to the meal

21. Fats Negligible (less than 10%) effect on blood sugar levels. Delays/slows the digestive process. The fat in fatty foods, i.e., french fries or chocolate, delays the absorption of the sugar.

22. Suggestions for Exercise/Sports Organized sports and other forms of active play are a great way for a child to stay physically fit. May need snack before intensive exercising (p.e.). Have extra snacks available during exercise. School staff supervising the exercise/sports activities must follow the emergency action plan.

23. Blood Sugar Testing Research has shown that maintaining good control of blood sugar levels can prevent long-term complications of diabetes Testing is often performed 3-4 times daily Helps determine appropriate treatment

24. Procedure 1. Student or nurse obtains a drop of blood which is then placed on a test strip. 2. Strip is placed in monitor and it gives a digital readout of current blood sugar level. BLOODBORNE PATHOGEN PRECAUTIONS ARE REQUIRED!

25. Diabetic Equipment and Supplies Provided by Parent May Include: Blood sugar testing kit Insulin and injection supplies Snacks Quick sugar sources Ketone testing supplies

26. FIELD TRIP REMINDERS Take the Emergency Action Plan Take emergency supplies (snack, quick sugar source, blood testing equipment, etc) Plan ahead, determine how to contact emergency services, to and from location. Take cell phone but confirm coverage area for trip Trained district staff or parent must be available to assist student.

27. Low Blood Sugar (Hypoglycemia) Is generally defined as blood sugar less than 60mg/dl (see student’s IHP). A low blood sugar episode does not feel good and it may be frightening to the student. Student may feel “low” and show any of the following symptoms:

28. Hypoglycemia (Low blood sugar, insulin reaction ) ** Symptoms * *caused by release of adrenalin

29. Additional symptoms Pale skin color Inability to concentrate Personality change

30. Causes of Low Blood Sugar Late or too little food Too much exercise Too much insulin

31. Treatment of Mild Low Blood Sugar Follow student’s emergency action plan. Student treats self by ingesting quick sugar source such as: Glucose tablets Juice 4-8 oz. Regular soda (non diet): 1/2 can 4 or 5 pieces of hard candy

32. Follow-up Treatment of Mild Hypoglycemia Wait 10-15 minutes and retest. If blood sugar remains <60 or if symptoms persist repeat quick sugar source. Follow with snack of complex carbohydrates and proteins (cheese and crackers) if next meal is > ½ hr away.

33. If blood sugar continues to fall you may see: Behavior changes Poor coordination Complaint of headache Confusion Blurry vision Weakness Slurred speech *treat the same as mild blood sugar

34. Severe Low Blood Sugar Seizure Loss of Consciousness Call 911

35. Treatment of Severe Low Blood Sugar Follow the student’s emergency action plan. Call 911. Position on side if possible. Don’t attempt to give anything by mouth.

36. EMERGENCY ALERT Low blood sugar can develop within minutes and requires immediate attention. Never send a student with suspected “low blood sugar” anywhere alone.

37. School Bus Considerations NEVER put a student with low blood sugar on the bus. Contact parent if a low blood sugar episode occurs within 30 minutes prior to departure (includes students walking home). Students having signs of low blood sugar and able to swallow should be allowed to eat a snack on the bus.

38. If You Have a Way to Check Blood Sugar, Do So. *BUT ALWAYS, WHEN IN DOUBT, TREAT WITH QUICK- ACTING SUGAR SOURCE

39. High Blood Sugar Hyperglycemia Blood sugar greater than 240 mg/dl. Occurs over time (hours to days). Students not yet diagnosed may exhibit some or all of the symptoms, including weight loss. Student may feel high and show any of the following symptoms:

40. Hyperglycemia (high blood sugar) Symptoms

41. Treatment of Hyperglycemia Follow emergency action plan Drink zero-calorie fluids, (i.e., water or diet soda) Check ketones, if test strips available (many students will not test for ketones at school) Decrease activity if ketones are present

42. Severe Hyperglycemia Very weak Confused Labored breathing Unconscious Coma Call 911

43. Treatment of Severe High Blood Sugar Follow the student’s emergency action plan. Call 911. Position on side if possible. Don’t attempt to give anything by mouth.

44. Long Term Effects of Hyperglycemia Vision problemsblindness Nervous system problems Kidney failuredialysis heart Vascular changes disease, amputations

45. The Law and Diabetes Diabetes is considered a disability under federal law (504). All students with diabetes must have a health care plan in place. Children with diabetes must have full access to all activities, services, or benefits provided by public schools.

46. Individual Health Care Plans/ HCP Orders Health Care Plans are individualized for each student. Each student will have an emergency action plan that specifies what to look for and what to do in an emergency. Prior to school entry, orders should have been received from the child’s health care provider (HCP). Check with your school nurse or office personnel for location of health care plans.

47. What is unlicensed diabetes care assistant (UDCA)? The principal must identify school employees (other than health care professionals) to serve as unlicensed diabetes care assistants, who will be trained to assist with daily or emergency care of students with diabetes if/when a school nurse is not available.

48. What is unlicensed diabetes care assistant (cont.) The principal must ensure that the school has at least one unlicensed assistant if the school has a full-time nurse; if there is no full-time nurse, the school must have at least three unlicensed assistants. A school employee may not be subject to any penalty or disciplinary action for refusing to serve as an unlicensed diabetes care assistant.

49. Suggested Accommodations Location for blood sugar monitoring and/or insulin injection will be determined by the School Nurse, parents, and student. Allow blood glucose monitoring as needed. Student may also need to check sugar on field trips or during special events.

50. Allow student to snack when and where necessary to maintain adequate blood sugar levels. Parents are responsible to supply snacks for school. At least one snack should be readily available for emergency consumption. If no response to the snack and/or symptoms worsen, accompany student to Nurse’s office or call for help in classroom.

51. Allow water to be consumed as needed. Allow bathroom privileges as needed. Exercise is essential. Parent may provide a “disaster kit” for their child which includes extra diabetic supplies in the event of an extended emergency at school. Parents should be given at least a one-day notice of extra events such as parties or ‘field days.’

52. When the student experiences either a high blood sugar reaction or a low blood sugar reaction, his/her thought processes are likely to be adversely affected. Accommodations will need to be made with regards to performance expectations during the time immediately before and for at least one hour after the episode is treated.

53. Special Considerations Don’t assume that the student wants/doesn’t want others to know of his/her diagnosis. Seek help when in doubt. NEVER SEND A STUDENT WITH SUSPECTED LOW BLOOD SUGAR TO THE NURSES’S OFFICE ALONE.

54. Common Parent Concerns Monitoring the health of the child during the school day. ‘Labeling’ the student only through his/her disease. Impact of diabetes on child’s educational performance. Why can’t any school staff do the things the parents do routinely at home? Can my child go to his/her neighborhood school? YOUR SCHOOL NURSE CAN HELP ADDRESS THESE CONCERNS

55. Resources Contact your school nurse with any questions or concerns.