1. Care for School Children With Diabetes Senate Bill 911/G.S. 115C-47

2. OVERVIEW OF SB 911 SECTION 2 Requires local school systems (LEA’s) to ensure that guidelines are implemented to schools in which students are enrolled LEA will make available necessary information and staff development in order to support the diabetes care plan requirements for students with diabetes

3. OVERVIEW OF SB 911 SECTION 1 Requires procedures for the development of a diabetes care plan if requested by parents Procedures must include provisions for a “regular” review Key components to include: Staff development for all school staff Development of an emergency care plan, including allowable actions to be taken Extent of the student’s control of diabetes care

4. Diabetes Awareness, Training and Action (DATA) Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) resulting from defects in insulin secretion, insulin action, or both. Diabetes Care Supplement, 2003

5. Diabetes Awareness Insulin is a hormone produced in the beta or islet cells in the pancreas It is necessary to move the sugar (glucose) in the bloodstream into the cells for metabolism to occur Glucose is essential to life and to keeping the cells in the body healthy

6. Diabetes Awareness Type 1 Diabetes Used to be known as Juvenile-Onset or Insulin Dependent Diabetes Results from the autoimmune destruction of the beta (or islet) cells of the pancreas which produce the hormone insulin A person cannot live without insulin

7. Diabetes Awareness Type 1 Diabetes Occurs in approximately 1:400 children (10% of the diabetic population) Often presents as an acute illness Requires insulin injections

8. Diabetes Awareness Type 2 Diabetes Used to be known as Adult-Onset or Non-Insulin Dependent Diabetes Characterized by insulin resistance that develops into insulin deficiency Is a rising epidemic among young people Central abdominal obesity is directly related to Type 2 diabetes

9. Diabetes Awareness Type 2 Diabetes Accounts for 90% of the world’s population with diabetes Insulin resistance means that insulin is produced, but the body is not using it correctly This resistance causes blood sugar levels to rise, resulting in diabetes

10. Diabetes Overview: Treatment Foundations The amount of insulin taken has to be balanced with food intake (specifically, carbohydrates) and levels of activity.

11. Diabetes Overview: Treatment Foundations Currently, most students are taking insulin by syringe, pen device or pump. The insulin pump is a type of injection using a very small catheter under the skin that continuously provides insulin The food intake is monitored by “counting carb’s” in the nutrition plan

12. Diabetes Overview: Treatment Foundations Tools for Diabetes Management Self-monitoring of blood sugar levels Is important for everyone with diabetes Is done by a blood glucose meter reading a drop of blood Is recorded in the person’s log

13. Diabetes Overview: Treatment Foundations Tools for Diabetes Management Carbohydrate Counting and Meal Planning To balance activity & insulin To calculate the dosage of insulin to administer To achieve and maintain a healthy weight level

14. Diabetes Overview: Treatment Foundations Tools for Diabetes Management Insulin Injection Most students take at least two insulin injections daily Some are on intensive insulin therapy or wear a pump

15. Diabetes Overview: Treatment Foundations Tools for Diabetes Management Senate Bill 911: Management Tools are to be available to the student at all times, in accordance with the individual diabetes care plan

16. Diabetes Overview: Acute Complications HYPERGLYCEMIA – High Blood Sugar Occurs when the body gets: Too little insulin, OR Too much sugar in the food eaten, OR Too little activity/physical exercise Hyperglycemia may also occur when the child has an illness, such as a cold

17. Diabetes Overview: Acute Complications HYPERGLYCEMIA – Symptoms Frequent Urination Extreme Hunger Extreme Fatigue Unusual Thirst Irritability Blurred Vision

18. Diabetes Overview: Acute Complications HYPERGLYCEMIA – High Blood Sugar In all high cases, if the student is able, s/he should drink lots of calorie-free, caffeine- free liquids, preferably water.

19. Diabetes Overview: Acute Complications HYPOGLYCEMIA – Low Blood Sugar Occurs when the body gets: Too much insulin, OR Too little sugar in the food eaten, OR Too much activity/physical exercise Hypoglycemia occurs when the body does not have enough sugar in the blood

20. Diabetes Overview: Acute Complications HYPOGLYCEMIA – Symptoms Hunger Shakiness Dizziness Sweatiness Fast heartbeat Drowsiness

21. Diabetes Overview: Acute Complications HYPOGLYCEMIA – Symptoms Feeling irritable Nervousness Pallor Stubbornness

22. Diabetes Overview: Acute Complications HYPOGLYCEMIA – Symptoms Lack of coordination Tingling, numbness of the tongue Personality change Passing out Seizure Death

23. Diabetes Overview: Acute Complications RECOGNIZING HYPOGLYCEMIA It is important to recognize a low blood sugar as soon as possible so that it does not progress to a severe reaction Early signs are caused by the release of adrenaline (epinephrine), the “fight or flight” hormone

24. Diabetes Overview: Acute Complications FREQUENT CAUSES OF HYPOGLYCEMIA Meals that are late or missed Extra exercise or activity An insulin dose that is too high Unplanned schedule changes

25. Diabetes Overview: Acute Complications WHAT TO DO IF HYPOGLYCEMIA OCCURS Contact DCM If possible, always do a blood sugar test first Have student eat/drink 15 grams of a fast-acting carbohydrate Wait 15 minutes and check blood sugar

26. Diabetes Overview: Acute Complications HYPOGLYCEMIA BUSTERS 2-4 Glucose Tablets 4 ounces of orange or apple juice 4-6 ounces of regular soda (not diet) 4-8 Lifesaver candies 3-4 teaspoons of sugar or syrup 1 tube of cake icing/gel

27. Diabetes Overview: Acute Complications Treating severe hypoglycemia Immediate action is necessary Glucagon may need to be injected Someone should be calling 911 Turn the person onto their side and keep comfortable

28. DATA Summary SB 911 is intended to eliminate discrimination and provide for student support and safety for those with diabetes.

29. DATA Summary Tools for Diabetes Management Senate Bill 911: Management Tools are to be available to the student at all times, in accordance with the individual diabetes care plan

30. DATA Summary All treatment is based on the Diabetes Care Plan provided by the parent in consultation with the student’s health care provider.

31. DATA Summary The Diabetes Care Managers (DCM’s) in each school provide support to all the school staff who are directly involved in the daily school life of the student with diabetes.

32. DATA Summary In the absence of a Diabetes Care Plan, the parent, the student or EMS/911 will have to assume responsibility for diabetes care for the student.