DiabetesInformation for

Schools

DiabetesInformation for

Schools

Reviewed: July 2015

Diabetes AwarenessDiabetes Awareness The aim of this talk is to raise

awareness of diabetes and the management of diabetes at school.

What is diabetes ?

Types of Diabetes

Management of diabetes at school

Roles and responsibilitiesRoles and responsibilities Parents to liaise with school re child’s

needs during school day. Parent will discuss and agrees the individual

healthcare plan for their child with school staff and paediatric diabetes specialist nurse (PDSN)

PDSN will complete training for school staff as required. ( this can take up to 5 days).

School nurse/community nurse can provide awareness talks for all school staff

DiabetesDiabetes

Affects 1 in 300 school age children and is a chronic condition.

It occurs when the amount of glucose (sugar) in the blood is too high because the body is not able to use it properly.

There are many different types of Diabetes but most commonly : Type1 and Type 2.

Early signs of DiabetesEarly signs of Diabetes Thirst Toilet (frequency) Thin (weight loss) Tiredness and lack of concentration ( may experience blurred vision)

* N.B teachers can often identify the signs that a child may be developing diabetes.

Type 1 Diabetes Type 1 Diabetes Auto immune condition causing the

destruction of insulin producing cells in the pancreas.

Without insulin the child’s body cannot use glucose and the blood glucose levels rise.

Most common type in children but not due to poor diet or lack of exercise

Treated with subcutaneous insulin, careful monitoring, and promotion of healthy eating.

Management of Type 1 DiabetesManagement of Type 1 Diabetes Diabetes cannot be cured but it can be treated

effectively Managed with a combination of insulin,

healthy eating & frequent blood glucose monitoring.– Insulin is destroyed by the digestive juices of the

stomach so must be given by injection.– Insulin lowers blood glucose level– Insulin doses need to be balanced with food intake

Aim is to keep blood glucose levels close to normal range 4 – 8mmol/l

Type 2 DiabetesType 2 Diabetes Body still makes some insulin but is insulin

resistant – Usually occurs in people over 40– Risk increased in children and young

people who are overweight.

Treated by:– Healthy eating & exercise , +/- tablets– May require Insulin injections also.

Normal Regulation of Blood GlucoseNormal Regulation of Blood Glucose

Blood Glucose TestingBlood Glucose Testing Children should test blood glucose levels regularly during school hours. Young children may need assistance to test

their blood glucose level. N.B child’s hands must be washed prior to

testing for accuracy. Involves pricking finger with a special device Blood placed on a reagent strip inserted in a

meter, which gives result in 5 sec.

Blood glucose testing cont’dBlood glucose testing cont’d

Parent/carers should discuss their child’s needs during school hours.

Training will be provided by the PDSN for school staff who volunteer to assist children as needed.

Parents/carers are responsible for the provision and disposal of all equipment including sharps boxes.

Blood glucose levelsBlood glucose levels Normal blood glucose range : 4 - 8mmol/l

Hypoglycaemia is a blood glucose level below 4 mmols/l and requires immediate action

Hyperglycaemia is 14mmol/l and above ( too high)

Prolonged hyperglycaemia increases the risk of complications effecting long term health.

Insulin delivery(injections)Insulin delivery(injections)

• Two/three injections daily – not in school or

• 4-5 injections daily – (1 before lunch) • Injections usually given with pen device• Parents/carers arrange with school safe

storage of insulin pen and a private area to inject.

• Children who are unable to self inject will require assistance at school.

• Training will be provided by the PDSN for volunteers who wish to help with this.

Where injections are given:Where injections are given: Environment – clean, private area (not

toilets) Injection sites recommended are highlighted

in the diagram as below and a new site used each time

Insulin delivery (pumps)Insulin delivery (pumps)• Increasingly popular method of insulin delivery,

especially in younger age group.• Delivers insulin continuously through a cannula

under the skin• Blood glucose levels must be tested before

any food is taken• Boluses of insulin are delivered via buttons on

the pump ( some children will need help with this)

• Parents and children need to be accurately counting carbohydrates for this method to be effective.

• Individualised training for school will be given as necessary.

Sharps DisposalSharps Disposal Parents responsibility to provide and dispose

of sharps boxes If child able , allow to remove own used pen

needle and dispose in sharps box If a needle stick injury occurs immediately

bleed the wound, then place under cold running water for 5 minutes and seek medical advice.

Dietary adviceDietary advice

We promote healthy eating as recommended for whole of the population

Low in sugar & fat & high in fibre Meals & snacks taken at regular intervals Most are trained to count carbohydrates to

give appropriate insulin doses. Diabetic products are not recommended

Meal timesMeal times

Younger children will need one to one supervision at break and lunch.

School dinners- parents responsible for calculating the carbohydrate content of foods.

Some pupils may be permitted access to the top of the queue at lunch time.

•Hypoglycaemia is the most common complication in diabetes •It occurs when the bloods glucose falls below 4mmols/l•The symptoms vary from child to child and are documented within their individual health care plan•Older children generally recognise their hypo and will take appropriate action themselves•The very young or newly diagnosed will require assistance

•Hypoglycaemia is the most common complication in diabetes •It occurs when the bloods glucose falls below 4mmols/l•The symptoms vary from child to child and are documented within their individual health care plan•Older children generally recognise their hypo and will take appropriate action themselves•The very young or newly diagnosed will require assistance

Hypoglycaemia (Hypo)

Hypoglycaemic treatment kitHypoglycaemic treatment kit Each pupil should have an individual healthcare plan

& hypoglycaemic kit which should be kept in school Parents/carers are responsible for

– Providing the hypoglycaemic kit, ensuring it is correctly labelled

– Ensuring all medication and food supplies are within expiry dates

– Replacing any used medication and food supplies– Ensuring any changes in medication or regimen

are notified promptly– Ensuring any changes in contact details including

emergency telephone numbers are notified promptly

Hypoglycaemia (causes)Hypoglycaemia (causes)

• Too much insulin• Missed food• Delayed food• Too much or too intense exercise• Unscheduled exercise• Hot weather• Alcohol• There may be no obvious cause

Mild Hypoglycaemia symptomsMild Hypoglycaemia symptoms Hunger

Shakiness Weakness Paleness Personality change Dizziness Sweating Drowsiness Anxiety Irritability

Symptoms will be different for each individual pupil

Management of Mild HypoglycaemiaManagement of Mild Hypoglycaemia• Give a fast acting sugar (15g CHO)

• 90 mls Lucozade – ½ a glass

OR• 150 mls Coke (non diet) – 1 glass

OR• 4-5 Glucose tablets

OR• 3-4 Fruit pastilles , or 3-4 jelly babies

OR 150 mls of fruit juice

• Remain with pupil until fully recovered usually 10 – 15 minutes - retest blood glucose (B.G)

• Repeat treatment above if symptoms persist• Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or snack is not

due within 30 minutes • Return to class if symptoms resolve and continue with normal activities including

snacks and meals• Document hypo and inform parents/carers as previously agreed .

Never use chocolate to treat a hypo, as it does not release the sugar quickly

Moderate Hypoglycaemia symptomsModerate Hypoglycaemia symptoms

Behaviour change Headache Blurred vision Slurred speech Poor co-ordination Confusion

Symptoms will be different for each individual pupil, these are recorded on their healthcare plan.

Management of Moderate HypoglycaemiaManagement of Moderate Hypoglycaemia If the pupil is cooperative treat as per mild hypoglycaemia If uncooperative but able to swallow Give GlucoGel as directed in healthcare plan.

– Twist off cap to break the seal– Give one tube of glucogel into the mouth between the gum and

cheek in small amounts and massage cheekDO NOT GIVE IF PUPIL CANNOT SWALLOW OR HAS “PASSED

OUT” Remain with pupil until fully recovered usually 10 – 15 minutes (retest) Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or

snack is not due within 30 minutes Return to class if symptoms resolve and continue with normal

activities including snacks and meal Inform parents/carers of hypoglycaemic episode If the child deteriorates becoming drowsy & unable to

swallow treat as per severe hypoglycaemia

Severe HypoglycaemiaSevere Hypoglycaemia

Unconscious

Unresponsive

Seizure with possible incontinence

Rarely occurs at school

Management of Severe HypoglycaemiaManagement of Severe Hypoglycaemia Do not give anything to eat or drink

Place in recovery position if possible Remain with pupil Call paramedic ambulance

– State hypoglycaemic episode– Give name & location of school– State where ambulance will be met– Assign someone to meet ambulance– Ensure pupil is accompanied in ambulance by a

responsible adult e.g parent/teacher– Advise ambulance crew of treatment administered– Give all used medication to ambulance crew

• Contact parents/carers ASAP

Summary of progression of hypoglycaemiaSummary of progression of hypoglycaemia

Mild hypoglycaemia goes untreated

Moderate hypoglycaemia goes untreated

Severe hypoglycaemia goes untreated

Can result in unconsciousness & coma

Promptness of diagnosis in early stages is essential in preventing progression of

hypoglycaemia

Recovery PositionRecovery Position

•Blood glucose level above 14mmol/l•Pupil may feel thirsty•Will need the toilet more frequently•May complain of a sore tummy or head and feel lethargic•Contact the parent for further advice•May become unwell if not managed as agreed in healthcare plan

•Blood glucose level above 14mmol/l•Pupil may feel thirsty•Will need the toilet more frequently•May complain of a sore tummy or head and feel lethargic•Contact the parent for further advice•May become unwell if not managed as agreed in healthcare plan

Hyperglycaemia

ExerciseExercise All pupils should be able to participate fully in all activities Exercise uses up glucose Exercise will not always drop blood glucose at the time of

activity due to adrenaline. Effects of exercise can last in the body for up to 18 – 24hrs

depending on duration and intensity. Blood glucose will fall if

– Not enough glucose has been taken prior to exercise– Too much energy is used during exercise and not replaced.– This may lead to hypoglycaemia

Preparation for ExercisePreparation for Exercise Before exercise blood glucose levels should be tested

and their hypo kit should be brought with the child. A small snack may need to be taken before, during or

after activity e.g Mini chocolate bar or Cereal bar or 2 plain

biscuits N.B. Some pupils will adjust their insulin prior

to sport and may not need a snack Hypo kit should include– Glucose tablets or – Sugary drink Following exercise more food may need to be taken

depending on the level of exercise, duration and intensity.

MythsMyths A diabetic diet does not exist (just healthy

eating for general population advised)

Diabetes is not caused by eating too many sweets

No one just has “A touch of diabetes”

No one grows out of diabetes

School Trips – Day TripsSchool Trips – Day Trips Reasonable steps should be taken by schools to

encourage pupils with medical needs to participate in school trips wherever safety permits, for further guidance refer to Supporting Pupils With Medication Needs DOE & DHSSPSNI 2007.

Take hypoglycaemic kit & action plan All diabetes medication and equipment required must

taken Food for journey in case of delays and contact numbers Mobile phone can be considered.

School Trips – Overnight StaysSchool Trips – Overnight Stays

Most pupils should be able to go on school trips provided reasonable steps are taken

Parents/carers/school staff should contact Diabetic Nurse Specialist at least a month prior to trip to discuss supervision and plan of care whilst away.

Take hypoglycaemic kit & healthcare plan Food for journey in case of delays Insulin injections/ pump supplies Blood glucose monitoring equipment Take double supplies which should be carried

separately in case of lost luggage etc. Mobile phone must be taken

ExaminationsExaminations Emotional stress and anxiety can cause

fluctuations in blood glucose levels Children/young people perform at their best

when diabetes is well controlled Blood glucose should be checked before

each exam Hypo treatment must be available Letter can be requested from their

consultant for special consideration in case of hypoglycaemic episode.

Diabetes UK Children with Type1diabetes at school :what all staff need to know www.diabetes.org.uk

DHPPS/DENI(2008) Supporting pupils with medication needs www.deni.gov.uk/support_with_medical_needs.pdf

RCN(2013) Supporting children and young people with diabetes www.org.rcn.uk

What Diabetes care to Expect in schools . (2015)compiled by DUK, PHA, Education and library boards NI

Diabetes UK Children with Type1diabetes at school :what all staff need to know www.diabetes.org.uk

DHPPS/DENI(2008) Supporting pupils with medication needs www.deni.gov.uk/support_with_medical_needs.pdf

RCN(2013) Supporting children and young people with diabetes www.org.rcn.uk

What Diabetes care to Expect in schools . (2015)compiled by DUK, PHA, Education and library boards NI

Useful links: