1. Diabetes Education Macon County Schools

2. Senate Bill 911 Requires schools to provide care to the student with diabetes upon parent request. Requires that all school personnel have a basic understanding of diabetes Requires that all schools have a designated Diabetes Care Manager with a back up in case that person is unavailable Requires the schools to have a diabetes care plan that is updated each school year.

3. Senate Bill 911 The student with diabetes should have access to any medical interventions that are necessary (insulin, water, juice or source of sugar) The student should have access to the bathroom and water as needed.

4. Type I & Type II Type I: used to be known as Juvenile onset or Insulin dependent Diabetes Mellitus IDDM –No insulin is being produced by the pancreas. An external source of insulin must be administered. Type II: used to be known as Adult onset or non insulin dependent diabetes mellitus NIDDM –Insulin resistance, “not enough”, or body is not responsive to the insulin that it is producing. Often can be controlled by medication that makes the body more responsive to insulin. After several years may become IDDM.

5. Insulin Insulin is a hormone. Insulin is necessary to move the glucose (sugar) that we get from our foods or drink from the blood stream to the cells where it can be used by the body as energy. Insulin is the mechanism through which glucose enters the cells.

6. Hyperglycemia –hyper – too much –Glycemia – glucose or sugar Hypoglycemia –Hypo – too little –Glycemia – glucose or sugar

7. High Blood Sugar (>240 mg/dl) Hyperglycemia (hyper - more) –Too little insulin, too much food, or too little exercise –May occur at times of illness even if there are appropriate levels of insulin, food or exercise. (infection, viruses) –Stress from school, home, or peers can elevate blood sugar levels. –Adolescence is a time of unpredictable periods of hyperglycemia.

8. Signs and symptoms of Hyperglycemia Frequent Urination* Extreme Hunger Extreme Fatigue Unusual Thirst* Irritability Blurred Vision

9. Exercise A Normal blood sugar range varies from person to person. An average range is 80- 120. If blood sugar is elevated > 300 mg/dl exercise should be delayed. When blood sugars are elevated the body uses muscle rather than carbohydrates as it’s energy source. Exercising when blood sugar levels are elevated can further damage muscle

10. Hypoglycemia Low Blood Sugar

11. Hypoglycemia Sometimes called “insulin reaction” Below target range (usually <70-80) Can come on quickly Caused by too much insulin, eating too few calories, or too much activity Not enough sugar in the blood Can become an immediate medical emergency if not treated quickly.

12. Hypoglycemia signs and symptoms HungerFeeling irritable, Shakinesssad or angry Dizziness SweatinessNervousness Fast heart beatPallor Drowsiness ( <7yo pale glassy eyed)

13. More symptoms of hypoglycemia Feeling sleepy Being stubborn Lack of coordination Tingling or numbness of the tongue Personality changes Passing out Seizure

14. What to do? If possible check blood sugar If Blood sugar is 70 or below target (See the diabetes care plan for specifics for each student), have the student eat or drink a source of quick acting sugar (15 gms. Carbs) If meter is not handy go ahead and have the student eat or drink a source of fasting acting sugar, then obtain the meter and check their blood sugar.

15. Fast-acting Carb’s 2-4 glucose tablets 4 oz apple or orange juice 4-6 oz soda 4-8 life savers 2 tablespoons raisins 3-4 teaspoons sugar or syrup 1 cup low fat milk 1 tube of cake gel

16. Catch low blood sugar EARLY Be alert to when lows may occur Test if there is any doubt Fast acting carb sources should always be available Treat low blood sugar promptly or it can turn into severe hypoglycemia- a medical emergency!!

17. Treating SEVERE hypoglycemia Not enough sugar is getting to the brain May lose consciousness and/or have convulsions MEDICAL EMERGENCY Glucose gel, cake gel, syrup, or honey may be used only if the student is still conscious

18. Unconscious Call 911 Administer Glucagon injection immediately Do not place anything into their mouth Glucagon is a hormone that makes the liver release sugar into the blood stream. It is similar to an epi pen. –Most people with diabetes will have Glucagon ordered in case of emergency.

19. Hypoglycemia REMEMBER!! When in doubt, treat the student as if he/she is LOW. Provide them a juice or source of quick acting sugar (sweet tarts, smarties). Avoid chocolate or sweets that have a high fat content as they are absorbed more slowly and are not considered “fast acting sugars.”

20. Field Trips Senate bill 911 requires that a diabetes care manager or parent be present on all field trips that the student with diabetes participates in. A school can NOT require that the parent participate but must make accommodations for the diabetes care manager or appropriate substitute (school nurse) be present for the trip.

21. Field Trips If the parent decides to participate it must be clearly communicated to the parent that the diabetes care manager or nurse will not be there and that they are assuming full responsibility for the medical care of their child.

22. Class Parties Planning ahead is the best thing. Notify parent and diabetes care manager in advance. The parent may decide to be present and to handle the balancing of food and insulin The student should be allowed whatever is offered to the other students.

23. Class parties The diabetes care manager can decide how to cover extra foods by administering insulin. Students with diabetes can eat foods with sugar. They just need to adjust for it. Sugar Free foods are not carbohydrate free and will still need to be covered with insulin. Sources of foods that do not contain carbohydrates and will not need to be adjusted for include: Cheese, meats, diet sodas and most vegetables.

24. Thank you!