1. PAEDIATRIC DIABETES SCHOOL MANGEMENT Jan Reddick PDNS

2. WHAT IS DIABETES? An imbalance between the insulin and the glucose in the human body What has gone wrong in diabetics? Normal insulin but ineffective – Type 2 No insulin – Type1 High sugar in the blood

3. The Pancreas, it is your body's own blood glucose monitoring system (INSULIN AND GLUCAGON)

4. How does it work

5. How does it present? Polyuria ( passing a lot of urine) (WHY) Polydipsia ( drinking a lot) (WHY) Weight loss (WHY) Lethargy / Tiredness and general fatigue (WHY) Dehydration, Acidosis ( Ketones) Drowsiness and Coma (DKA)

6. Treatment Daily Insulin injections with each meal and snack that contains carbohydrate (amount varies on the child's individual insulin to carbohydrate ratio) Healthy eating, ideally each meal should contain carbohydrate Exercise Blood glucose tests pre main meals (lunch), pre PE lessons and if the child looks or feels unwell. The aim is to maintain near normal blood sugars. (4-9Mmol/L)

7. BASAL BOLUS

8. Multiple Injections Advantages Can vary the dose of insulin to the amount of carbohydrate eaten. No guilt feeling. Can eat at variable times Can correct for too high or too low blood glucose levels Significant improvement in life style Easier to deal with illness Less likely to get hypos If used well can improve control considerably

9. Symptoms of hypoglycaemia PalenessPalpitation ShakinessIrritability HeadacheLack of concentration SweatingConfusion hungryCrying DizzinessWeakness

10. Symptoms of severe Hypo Very drowsy Extremely disorientated Unconscious May have a brief fit or convulsion

11. Causes of hypoglycaemia? Exercise without eating enough carb. Missed or delayed meals Having too much insulin Illness (vomiting/diarrhoea) Hot weather

12. Treatment of Hypoglycaemia If conscious: –Immediately intake of simple sugars e.g dextrose tablets or Lucozade (amount dependent on individual child follow their plan) We only want to correct blood glucose level back to 6-8 Mmol/l no higher. -Follow with a carbohydrate based snack such as plain biscuit (amount dependent on individual child follow their plan), –Retest blood glucose to check rising above and child safe –If the child refuses to eat or drink and conscious then use Hypostop instead of the fast acting glucose. If unconscious: –999 and Glucagon injection

13. Causes of Hyperglycaemia? No insulin or to little insulin To much Carbohydrate in meal Correction of a hypoglycaemia Illness Stress

14. Treatment of Hyperglycaemia If the child is well, give a correction dose of insulin with the next meal. The correction dose is individual to each child so follow their plan or confirm with the parent. (correction doses should be 4 hours apart and ideally given at mealtimes). If the child is well then they can continue their school day as normal. If the child is unwell and the blood glucose is 15Mmol/l and above call the parents to collect and administer a correction dose of insulin as per healthcare plan.

15. Diabetes Type 1 Any other questions?