1. WHAT EVERY EDUCATOR SHOULD KNOW…….
DIABETES IN SCHOOL
WHAT EVERY EDUCATOR SHOULD KNOW…….

2. IDEA – Public Law 94-142 Student Rights
Free and appropriate Public Education
Least restrictive environment
Eligible students receive services to meet their individual needs (IEP)
Diabetes classified as “Other Health Impairment”

3. Rehabilitation Act – Section 504
Protects persons with disabilities from being excluded from participation in any program or activity receiving federal funding
A 504 plan may be written to specifically state the accommodations necessary to meet the student’s needs at school

4. Texas State House Bill 984 Applies to campus with diabetic students
Principal designates 3 campus employees (who are not healthcare professionals) to serve as Unlicensed Diabetic Care Assistants (UDCA)
School nurse provides training to the UDCA

5. House Bill 984 (cont’d) UDCA Training
Treatment of high and low blood sugar
Testing of blood glucose and ketones
Administration of glucose gel, glucagon, and insulin
Management of Student’s Individualized Healthcare Plan (IHP)

6. What is Diabetes?
Diabetes is a serious, chronic disease that impairs the way the body uses food (specifically sugar/glucose)
Insulin, a hormone produced by the pancreas, helps the body convert food into energy
In diabetes, the pancreas does not make insulin (Type I) or cannot use the insulin properly (Type II)

7. What is Diabetes?
Insulin deficiency or inefficiency causes the blood sugar level to be too high or too low
Diabetes cannot be cured, only managed
Diabetics must carefully balance food, medication and activity levels to keep the blood sugar as close to normal as possible
Low blood sugar and high blood sugar can be life threatening

8. Types of Diabetes Type I Pancreas does NOT produce insulin
Must receive insulin through injections or a pump (Insulin Dependent)
Most common type afflicting school-age children
Causes: genetic or autoimmune post infection
Type II
Insulin is overproduced by the pancreas, and receptor cells become resistant
May be controlled with diet and exercise
May require oral medication (i.e. glucophage) and/or injections of insulin
Obesity is a high risk factor, as is over consumption of sugars
In past, usually onset is late adulthood
Recently, children have become afflicted

9. Diabetic Management at School
The student may have to visit the nurse at scheduled times for blood testing and/or insulin injections as well as urine testing
It is the responsibility of the teacher, student, teacher and nurse to ensure testing and/or medications are administered on time
Special arrangements should be made in the event of field trips or class parties to ensure that a UDCA accompanies the student

10. Diabetic Management at School
It may be necessary for a diabetic student to eat a snack in the classroom to maintain adequate blood sugar levels
Depending on maturity, blood sugar testing may be performed in the classroom
Insulin will generally be administered in the clinic
Some students have insulin pumps which automatically administer calculated amounts of insulin, and additional amount (bolus) of insulin can be given without giving the student a “shot”

11. Diabetic Management at School
The student may need special scheduling for lunch and must be allowed adequate time to finish all meals
The student may require quick acting sugar to be available at all times
The student may require a free access to water, and may carry a water bottle
The student will require free access to the restroom

12. HYPOglycemia ( LOW blood sugar)
Caused when the body gets too much insulin, too little food, a delayed meal, or more exercise than usual
Symptoms
Sweating
Impaired Vision
Weakness/Fatigue/Sleeping in Class
Headache
Light-headedness
Irritability
Anxious
Confusion/Inability to follow directions
Hunger
Shakiness/Fainting
Fast Heartbeat

13. HYPERglycemia (HIGH Blood Sugar)
Occurs when the body gets too little insulin, too much food, or too little exercise
May also be caused by stress or illness
SYMPTOMS:
Excessive thirst
Frequent urination
Blurry vision
Fast heart rate, rapid breathing
Nausea/vomiting
Hunger
Dry Skin
Drowsiness

14. Hyperglycemia can lead to Ketoacidosis!
Ketoacidosis means dangerously high levels of acids that build up in the blood, upsetting the chemical balance
Ketones appear in the urine when your body does not have enough insulin and is breaking down fat for energy
Ketones can also appear when a diabetic is ill (i.e. with a cold/flu)
Ketoacidosis can lead to diabetic coma or even death; it will be treated in the hospital

15. Treatment of Symptoms
Always allow a student with symptoms to go to the nurse immediately
Never allow a student with symptoms to go to the clinic by him/herself
Only staff members who are trained in diabetes management should treat a symptomatic student
Hypoglycemia will be treated with glucose tablets, gel, juice/snacks or soda according to the student’s IHP
Hyperglycemia will be treated with insulin administered by a nurse or trained UDCA only

16. EMERGENCY CARE
HYPOglycemia and HYPERglycemia can both be potentially life threatening and must be treated immediately
9-1-1 and Trained Staff members should be contacted immediately
Hypoglycemia may cause unconsciousness or seizures and may be treated with Glucagon administered by nurse or UDCA

17. Your Student With Diabetes
Will have an Individualized Health Plan, specific to his/her diabetes management
Will have specific instructions for emergency care management
Will have specific equipment/supplies/snacks

18. What YOU need to do
Meet with the school nurse to obtain specific information about students with diabetes under your instruction or supervision and attend training
Read the accompanying attached handout “A Guide to Diabetes in the School”
Inform you school nurse at least 2 weeks prior to any off-campus trips or activities

19. What YOU need to do
Clip the handout to your grade/attendance book for your substitute’s reference
Always keep fast acting sugars such as hard candy/juice or sodas available
Please ask for clarification about Diabetes and the management of a diabetic student from your school nurse

20. Other Misc Info
Diabetes diet…Just as any other person, the diabetic should eat a well balanced, healthy diet from a variety of food sources
Type I Diabetics are not restricted from eating candy or high sugar foods, but as with any child, it should not be a significant source of their diet and all sugars need to be managed with insulin
All Carbohydrates (Carbs) contain sugars

21. Carbohydrate Counting
Calories in food give the body energy through nutrients:
Carbohydrates
Protein
Fat
Each nutrient affects blood sugar differently

22. Carbohydrate Counting
Total carbohydrates is what is used to determine how much insulin is needed
Another component of carbohydrate monitoring is whether the “carb” is slow acting or fast acting
Fast Acting Carbohydrates are absorbed quickly into the bloodstream
Slow Acting Carbohydrates are absorbed over a longer period of time

23. Rapid vs Slow Acting Carbs
Rapid acting carbohydrates
Will usually be absorbed within minutes and be absorbed (gone) from the bloodstream within one hour
Typically contain only sugars: examples hard candy, juice, soda, gel frosting

24. Slow Acting Carbohydrates
Onset of absorption is slower and over a longer period of time (hours)
Comprised of starchy sugars or sugars combined with other nutrients such as protein or fat…examples include candy bars, peanut butter, fruits, bread, ice cream….

25. Rapid vs. Slow Carbs (cont’d)
Rapid acting is needed when blood sugar is low (Below 80) so the blood sugar does not continue to decline
Slow acting carbs are needed to keep the blood sugar from dropping between meal times

26. Diabetes other facts
Student with diabetes are often on various types of insulin
Student growth patterns also impact the body’s management of insulin and blood sugar
Diabetes can be unpredictable
Parents and students need our support

27. Thank you for attending training on Diabetes!